An谩lisis mediante resonancia magn茅tica cardiaca del miocardio salvado tras infarto. Predictores e influencia en el remodelado adverso ventricular

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• 作者：José ; V. Monmeneup>ap>p> ; p>p>jmonmeneu@eresa.comp> ; Vicente Bodí ; p>bp> ; Marí ; a P. Ló ; pez-Lereup>ap> ; Juan Sanchisp>bp> ; Julio Nú ; ñ ; ezp>bp> ; Fabiá ; n Chaustrep>cp> ; Oliver Husserp>bp> ; Pilar Merlosp>bp> ; Clara Bonanadp>bp> ; Gema Miñ ; anap>bp> ; Francisco J. Chorrop>bp> ; Angel Llá ; cerp>bp>
• 关键词：IAMCEST ; infarto agudo de miocardio con elevació ; n del ST ; ICP ; intervenció ; n coronaria percutá ; nea ; IMS ; í ; ndice de miocardio salvado ; RMC ; resonancia magn&eacute ; tica cardiaca ; STIR ; short tau inversion recovery ; VI ; ventrí
• 刊名：Revista Espa?ola de Cardiolog篓陋a
• 出版年：2012
• 期刊代码：pca308_03008932
• 类别：med
• 出版时间：July, 2012
• 卷：65
• 期：7
• 页码：634-641
• 文件大小：681 K

摘要

Introduction and objectives

<p>To evaluate by cardiovascular magnetic resonance those factors related to the amount of salvaged myocardium after a myocardial infarction and its value in predicting adverse ventricular remodeling.

Methods

<p>One hundred eighteen patients admitted for a first ST elevation myocardial infarction (primary angioplasty, 65 patients; a pharmacoinvasive strategy, 53 patients) underwent magnetic resonance (6 [5-8] days and 6 months; n=83). The myocardial salvage index was quantitatively assessed as the percentage of area at risk (T2-weighted sequences) not showing late enhancement.

Results

<p>Myocardial salvage index >31%(median) was associated with a shorter time to reperfusion (153 min vs 258 min), a lower rate of diabetes (12%vs 32%), shorter time to magnetic resonance, and better cardiovascular parameters (m>Pm><.05 for all analyses). There were no significant differences depending on the reperfusion method. In a logistic regression analysis, delayed reperfusion (odds ratio=0.42 [0.29-0.63]; m>Pm><.0001), diabetes (odds ratio=0.32 [0.11-0.99]; m>Pm><.05) and a longer time to the performance of magnetic resonance (odds ratio=0.86 [0.76-0.97]; m>Pm><.05) were independently related to a lower probability of a myocardial salvage index >31%. Predictors of increased left ventricular end-systolic volume at 6 months were the number of segments showing an extent of transmural necrosis >50%(odds ratio =1.51 [1.21-1.90]; m>Pm><.0001) and left ventricular end-systolic volume at one week (odds ratio=1.12 [1.06-1.18]; m>Pm><.0001).

Conclusions

<p>Cardiovascular magnetic resonance enables the quantification of the salvaged myocardium after myocardial infarction. The celerity with which reperfusion therapy is administered constitutes its most important predictor. The possible effect of a delay in the performance of magnetic resonance on myocardial salvage needs to be confirmed. Salvaged myocardium does not improve the value of magnetic resonance for predicting adverse remodeling.<p>m>Full English text available from:m>