Paiva Luis, Ferreira Maria João, Afonso Sónia, Donato Paulo, Gonçalves Lino
Centro Académico e Clínico de Coimbra (CACC), Coimbra, Portugal.
Coimbra Institute for Clinical and Biomedical Research (iCBR), Universidade de Coimbra, Coimbra, Portugal.
Front Cardiovasc Med. 2025 May 23;12:1563368. doi: 10.3389/fcvm.2025.1563368. eCollection 2025.
Cardiac magnetic resonance (CMR) imaging allows tracking of ongoing fibrosis modifications following myocardial infarction (MI). We evaluated temporal changes in late gadolinium enhancement (LGE) and extracellular volume fraction (ECV) within the MI culprit coronary artery and remote regions of the myocardium during the index ischemic event and follow-up in patients with NSTEMI.
This prospective, single-center study included 30 patients with type 1 NSTEMI. It involved the evaluation of patients using coronary angiography, invasive coronary physiology, and biomarkers. CMR imaging was used to assess left ventricular (LV) volume, function, and myocardial fibrosis using LGE and ECV. These assessments were performed at baseline and repeated 6-10 months after MI.
At the 4-year post-MI follow-up, 27 patients survived [age 65 (58,74) years; 77% male], and LV mass, volume, and contractility remained unchanged between the baseline and follow-up measurements. Myocardial fibrosis assessed using LGE showed a decreasing trend at follow-up (9.4 ± 4.4% vs. 6.7 ± 4.4%; = 0.051), particularly in the MI culprit coronary artery regions (14.2 ± 8.6% vs. 9.5 ± 7.0%; = 0.015). LGE volume regression was observed in 70% of cases. The ECV measurements did not change between the initial and follow-up CMR assessments. Despite the high prevalence of multivessel coronary artery disease (CAD) (53%), no significant changes in LGE or ECV measurements were observed in the remote myocardium.
After NSTEMI, LGE decreased in the heart regions supplied by the culprit coronary arteries. However, the ECV measurements remained unchanged. Multivessel CAD was not associated with significant changes in myocardial fibrosis in the remote myocardium.
心脏磁共振成像（CMR）能够追踪心肌梗死（MI）后持续的纤维化改变。我们评估了非ST段抬高型心肌梗死（NSTEMI）患者在首次缺血事件期间及随访过程中，梗死相关冠状动脉及心肌远隔区域的延迟钆增强（LGE）和细胞外容积分数（ECV）的时间变化。
这项前瞻性单中心研究纳入了30例1型NSTEMI患者。研究包括使用冠状动脉造影、有创冠状动脉生理学和生物标志物对患者进行评估。CMR成像用于通过LGE和ECV评估左心室（LV）容积、功能和心肌纤维化。这些评估在基线时进行，并在MI后6 - 10个月重复进行。
在MI后4年的随访中，27例患者存活[年龄65（58,74）岁；77%为男性]，LV质量、容积和收缩性在基线和随访测量之间保持不变。使用LGE评估的心肌纤维化在随访时呈下降趋势（9.4±4.4%对6.7±4.4%；P = 0.051），特别是在梗死相关冠状动脉区域（14.2±8.6%对9.5±7.0%；P = 0.015）。70%的病例观察到LGE容积缩小。初始和随访CMR评估之间ECV测量值没有变化。尽管多支冠状动脉疾病（CAD）的患病率很高（53%），但在心肌远隔区域LGE或ECV测量值没有观察到显著变化。
NSTEMI后，梗死相关冠状动脉供血的心脏区域LGE降低。然而，ECV测量值保持不变。多支CAD与心肌远隔区域心肌纤维化的显著变化无关。
