Myokardiale Gewebeveränderung nach akut revaskularisiertem Nicht-ST-Hebungsinfarkt mittels kardialer Magnetresonanztomographie
Purpose: The aim of this study was to assess left ventricular function, myocardial oedema, late gadolinium enhancement, papillary muscle involvement and microvascular obstruction in acute and reperfused Non-ST elevated myocardial infarction (NSTEMI) and to investigate changes of cardiac magnetic resonance imaging (CMR) characteristics in chronic phase. Methods: 53 patients presenting with NSTEMI underwent CMR between 36 and 96 hours after symptom onset on a 1.5T whole-body scanner after coronary angiography. Left ventricular volumes and function were assessed using a steady-state free-precession sequence in short-axis geometry. Myocardial oedema was evaluated using a 3D T2-weighted sequence. The area at risk was calculated in relation to myocardial left ventricular mass. A 3D late gadolinium enhancement (LGE) sequence was used for calculation of infarct size and microvascular obstruction. The CMR examination was repeated 90 days after the index event. Results: Left ventricular mass (p<0.0001), infarct size (p=0.007) and microvascular obstruction (p=0.02) were significantly reduced at the follow-up examination. In patients with observed microvascular obstruction, infarct size was significantly larger (p=0.003).Patients with myocardial salvage index higher than the median had significantly smaller left ventricular end-diastolic volume indices (p=0.03), higher ejection fractions (p=0.004) and smaller infarcts (p=0.04) than patients with a myocardial salvage index less or equal the median. These groups also differed significantly in changes of infarct size and microvascular obstruction size between baseline and follow-up CMR examination. Conclusion: We could demonstrate the ability of CMR to quantify myocardial tissue characteristics assigned to the acute and chronic phase in NSTEMI patients. This method may influence revascularization strategies and clinical decision making in the future.
Subject HeadingsHerzinfarkt [GND]
Heart diseases; Radiography [MeSH]
Heart; Radiography [MeSH]
Magnetic resonance imaging [MeSH]
Myocardial infarction [MeSH]