Salatzki Janek, Giannitsis Evangelos, Hegenbarth Anastasia, Mueller-Hennessen Matthias, André Florian, Frey Norbert, Biener Moritz
Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
Eur Heart J Acute Cardiovasc Care. 2024 Feb 9;13(1):24-35. doi: 10.1093/ehjacc/zuad128.
Myocardial scarring due to acute myocardial infarction (AMI) can be visualized by late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) imaging. However, a recent study revealed a group of Type 1 AMI patients with undetectable myocardial injury on LGE. This study aims to describe these cases in detail and explore possible explanations for this new phenomenon.
A total of 137 patients diagnosed with either ST-elevation myocardial infarction (STEMI) or non-ST-elevation myocardial infarction (non-STEMI) diagnosed according to the 4th Universal Definition of Myocardial Infarction underwent LGE-CMR after invasive coronary angiography. Fourteen of them (10.2%) showed no LGE and were included in the final study population. Most patients presented with acute chest pain, 3 patients were diagnosed as STEMI, and 11 as non-STEMI. Peak high-sensitive cardiac troponin T ranged from 45 to 1173 ng/L. A culprit lesion was identified in 12 patients. Severe coronary stenoses were found in five patients, while seven patients had subtotal to total coronary artery occlusion. Percutaneous coronary intervention was performed in 10 patients, while 2 patients required coronary artery bypass grafting and no intervention was required in 2 patients. Cardiac magnetic resonance was performed 30 (4-140) days after the initial presentation. Most patients showed preserved left ventricular ejection fraction on CMR. No alternative reasons for the rise/fall of high-sensitive cardiac troponin T were found.
The absence of LGE on CMR in patients with Type 1 AMI is a new finding. While insufficient spatial resolution of LGE imaging, delayed CMR performance, spontaneous reperfusion, and coronary collaterals may provide some explanations, further investigations are required to fully understand this phenomenon.
急性心肌梗死（AMI）所致的心肌瘢痕可通过心脏磁共振成像（CMR）上的延迟钆增强（LGE）来显示。然而，最近一项研究发现一组1型AMI患者在LGE上未检测到心肌损伤。本研究旨在详细描述这些病例，并探讨这一新现象的可能原因。
根据第4版心肌梗死通用定义诊断为ST段抬高型心肌梗死（STEMI）或非ST段抬高型心肌梗死（非STEMI）的137例患者在进行有创冠状动脉造影后接受了LGE-CMR检查。其中14例（10.2%）未显示LGE，被纳入最终研究人群。大多数患者表现为急性胸痛，3例诊断为STEMI，11例诊断为非STEMI。高敏心肌肌钙蛋白T峰值范围为45至1173 ng/L。12例患者发现罪犯病变。5例患者发现严重冠状动脉狭窄，7例患者存在冠状动脉次全闭塞至完全闭塞。10例患者接受了经皮冠状动脉介入治疗，2例患者需要冠状动脉旁路移植术，2例患者无需干预。在初次就诊后30（4 - 140）天进行心脏磁共振检查。大多数患者在CMR上显示左心室射血分数保留。未发现高敏心肌肌钙蛋白T升高/降低的其他原因。
1型AMI患者CMR上无LGE是一项新发现。虽然LGE成像的空间分辨率不足、CMR检查延迟、自发再灌注和冠状动脉侧支循环可能提供一些解释，但需要进一步研究以充分理解这一现象。
