通过心脏磁共振目视评估缺血程度,而不是定量灌注指标,可以预测冠状动脉搭桥术的症状改善。

IF 6.1 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Tamim Akbari, Lukas Mach, Daniel J Hammersley, Suzan Hatipoglu, Ruth Owen, Dylan Taylor, Joyce Wong, Shahzad G Raja, Sunil K Bhudia, Dudley J Pennell, Brian P Halliday, Richard E Jones, Sanjay K Prasad
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引用次数: 0

摘要

背景:连续灌注心血管磁共振(CMR)可以为有症状的冠状动脉旁路移植术(CABG)患者提供心肌动态异常的机制。目的:评估心脏再灌注和重构的改变与CABG患者症状改善的关系。方法:等待选择性CABG的患者在基线和CABG后6-12个月完成一系列生活质量问卷和详细的CMR。自动全定量计算应激和休息心肌血流量,同时评估视觉缺血负担。结果与症状的改变相关。结果:在40例接受CMR系列评估的患者中(平均年龄62.1±9.3岁,中位LVEF 68% [IQR: 62-73%]),中位视觉缺血负担有所改善(42% [IQR: 27-51] vs 18% [IQR: 11-21])。结论:连续灌注CMR可识别冠脉搭桥患者心肌灌注标志物的动态变化。目视评估的缺血性更大的减少与SAQ-7评分的改善相关。在本研究中,定量灌注指标与症状改善无相关性。结果还表明,CABG后残留的诱导性缺血需要进一步的研究来阐明其临床相关性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Visually assessed ischaemia on cardiac magnetic resonance, but not quantitative perfusion metrics, predicts symptomatic improvement in coronary artery bypass.

Background: Serial perfusion cardiovascular magnetic resonance (CMR) in symptomatic patients undergoing coronary artery bypass grafting (CABG) may provide mechanistic insight into dynamic abnormalities of the myocardium.

Objectives: To assess how changes in cardiac reperfusion and remodelling associate with symptom improvement in patients undergoing CABG METHODS: Patients awaiting elective CABG completed serial quality of life questionnaires and detailed CMR at baseline and at 6-12 months post CABG as per protocol. Automated fully quantitative stress and rest myocardial blood flow was calculated, alongside assessment of the visual ischaemic burden. Findings were correlated with changes in symptomatology.

Results: Of 40 patients who underwent serial evaluation with CMR (mean age 62.1±9.3, median LVEF 68% [IQR: 62-73%]), there was improvement in the median visual ischaemic burden (42% [IQR: 27-51] vs 18% [IQR: 11-21], P<0.001), mean global stress myocardial blood flow (1.34±0.5ml/min/g vs 1.59±0.5ml/min/g, P=0.002) and median global myocardial perfusion reserve (1.85±0.6 vs 2.4±0.9, P<0.001) following CABG. Greater improvement in the SAQ-7 summary score was associated with a greater decrease in the visual ischaemic burden following CABG (ρ=-0.38, P=0.02). Quantitative MBF metrics did not associate with baseline or change in SAQ-7 summary score.

Conclusion: Serial perfusion CMR identifies dynamic changes in markers of myocardial perfusion in patients following CABG. Greater reduction of visually assessed ischaemia associated with improvement in SAQ-7 score. Quantitative perfusion indices were not associated with symptom improvement in this study. The results also suggest residual inducible ischaemia post CABG requiring further studies to elucidate its clinical relevance.

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来源期刊
CiteScore
10.90
自引率
12.50%
发文量
61
审稿时长
6-12 weeks
期刊介绍: Journal of Cardiovascular Magnetic Resonance (JCMR) publishes high-quality articles on all aspects of basic, translational and clinical research on the design, development, manufacture, and evaluation of cardiovascular magnetic resonance (CMR) methods applied to the cardiovascular system. Topical areas include, but are not limited to: New applications of magnetic resonance to improve the diagnostic strategies, risk stratification, characterization and management of diseases affecting the cardiovascular system. New methods to enhance or accelerate image acquisition and data analysis. Results of multicenter, or larger single-center studies that provide insight into the utility of CMR. Basic biological perceptions derived by CMR methods.
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