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心血管磁共振在侵袭性冠状动脉血管学之前,怀疑非ST段升高心肌梗塞

Mayooran Shanmuganathan¹, Chrysovalantou Nikolaidou², Matthew K Burrage³

¹Acute Vascular Imaging Centre, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom; Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, National Institute for Health and Care Research Oxford Biomedical Research Centre, Oxford British Heart Foundation Centre of Research Excellence, University of Oxford, Oxford, United Kingdom; Oxford University Hospitals National Health Service Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom.

JACC. Cardiovascular imaging

|July 6, 2024

概括

心脏磁共振 (CMR) 在疑似非ST段升高MI (NSTEMI) 病例中有效诊断心肌梗塞 (MI). 这种成像策略重新分类了超过50%的患者的诊断,指导了适当的管理.

科学领域:

心脏病学心脏病学
医疗成像医学成像
诊断医学诊断医学诊断医学

背景情况:

怀疑非ST段升高心肌梗塞 (NSTEMI) 诊断往往是不确定的,特别是在非阻塞性冠状动脉 (NOCA) 或当心脏病相关动脉被错误识别时.
准确的诊断对于适当的患者管理和治疗策略至关重要.

研究的目的:

在侵入性冠状动脉血管造影 (ICA) 之前,评估心脏磁共振 (CMR) 在疑似NSTEMI患者的诊断价值.
确定CMR是否可以准确识别心肌梗塞 (MI) 并将其与其他心脏病理区分开来.

主要方法:

怀疑NSTEMI的100名稳定患者接受了ICA前的CMR,包括cine,T2加权成像,T1映射和晚期加多增强.
CMR解释对ICA的发现是盲目的,临床团队对CMR结果是盲目的,直到ICA后.

主要成果:

在67%的患者中,CMR证实了心脏病发作 (52%的心脏下,15%的心脏外).
在18%的患者中发现了非血清性病理 (例如,心肌炎, takotsubo),11%的患者有正常的CMR发现.
在NOCA患者中,CMR在67%的病例中重新分类了诊断,在大多数病例中确定了非缺血性原因或正常发现.

结论:

在怀疑NSTEMI的CMR-first方法中,在67%的病例中识别出MI.
在至少50%的个体中,CMR通过重新分类诊断,显著影响患者管理.
CMR有助于区分缺血性与非缺血性心脏病,并可以识别正确的心脏病相关动脉.

关键词:

在CMR中,CMR是CMR.米诺卡 (MINOCA) 是一个小行星.在 NSTEMI 里面.急性冠状动脉综合征是什么早期心脏磁共振是什么意思肌性心肌炎是一种心肌炎.

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