- 作者：Jonathan Lessick ; Sobhi Abadi ; Yoram Agmon ; Zohar Keidar ; Shemi Carasso ; Doron Aronson ; Eduard Ghersin ; Shmuel Rispler ; Anat Sebbag ; Ora Israel ; Haim Hammerman ; Ariel Roguin
- 关键词：Myocardial infarction ; Viability ; Remodeling ; Perfusion defect ; Multidetector CT
- 刊名：European Journal of Radiology
- 出版年：2012
- 出版时间：October, 2012
- 年：2012
- 卷：81
- 期：10
- 页码：2648-2657
- 全文大小：1859 K
Background
Despite advent of rapid arterial revascularization as 1st line treatment for acute myocardial infarction (AMI), incomplete restoral of flow at the microvascular level remains a problem and is associated with adverse prognosis, including pathological ventricular remodeling. We aimed to study the association between multidetector row computed tomography (MDCT) perfusion defects and ventricular remodeling post-AMI.Methods
In a prospective study, 20 patients with ST-elevation AMI, treated by primary angioplasty, underwent arterial and late phase MDCT as well as radionuclide scans to study presence, size and severity of myocardial perfusion defects. Contrast echocardiography was performed at baseline and at 4 months follow-up to evaluate changes in myocardial function and remodeling.
Results
Early defects (ED), late defects (LD) and late enhancement (LE) were detected in 15, 7 and 16 patients, respectively and radionuclide defects in 15 patients. The ED area (r = 0.74), and LD area (r = 0.72), and to a lesser extent LE area (r = 0.62) correlated moderately well with SPECT summed rest score. By univariate analysis, follow-up end-systolic volume index and ejection fraction were both significantly related to ED and LD size and severity, but not to LE size or severity. By multivariate analysis, end-systolic volume index was best predicted by LD area (p < 0.05) and ejection fraction by LD enhancement ratio.
Conclusions
LD size and severity on MDCT are most closely associated with pathological ventricular remodeling after AMI and may thus play a role in early identification and treatment of this condition.