Dual-phase multi-detector computed tomography assesses jeopardised and infarcted myocardium subtending infarct-related artery early after acute myocardial infarction

被引：4
作者：
Chiou, K-R [1 ,2 ]
Huang, W-C [1 ,2 ]
Peng, N-J [2 ,3 ]
Huang, Y-L [2 ]
Hsiao, S-H [1 ,2 ]
Chen, K-H [2 ]
Wu, M-T [2 ,4 ]
机构：
[1] Kaohsiung Vet Gen Hosp, Dept Internal Med, Kaohsiung 813, Taiwan
[2] Natl Yang Ming Univ, Sch Med, Taipei 112, Taiwan
[3] Kaohsiung Vet Gen Hosp, Dept Nucl Med, Kaohsiung 813, Taiwan
[4] Kaohsiung Vet Gen Hosp, Sect Thorac & Circulat Imaging, Dept Radiol, Kaohsiung 813, Taiwan
来源：
HEART | 2009年 / 95卷 / 18期
关键词：
NONINVASIVE CORONARY-ANGIOGRAPHY; CT ANGIOGRAPHY; PERFUSION; VIABILITY; VALIDATION; ACCURACY; LESIONS;
D O I：
10.1136/hrt.2008.164772
中图分类号：
R5 [内科学];
学科分类号：
1002 ; 100201 ;
摘要：
Objectives: To investigate dual-phase multi-detector computed tomography (MDCT) for assessing extent and severity of jeopardised and infarcted myocardium subtended by infarct-related artery (IRA), and its indication for revascularisation after acute myocardial infarction (AMI). Designs, setting and patients: Prospective, single-centre study included 107 patients with uncomplicated post-AMI 3-7 days, who met criteria and underwent dual-phase 64-slice MDCT. IRA, culprit lesion and extent of jeopardised/infarcted myocardium were assessed by three-dimensional (3D) volume-rendered images with myocardium maps and computed tomography angiography (CTA), compared with stress-redistribution thallium-201 single-photon emission computed tomography (SPECT) plus conventional coronary angiography (CCA). MDCT-jeopardised score (severity of jeopardised myocardium) was defined as extent of jeopardised myocardium multiplied by the weighted factor dependent on culprit lesion severity compared with SPECT-SRS (summation of segmental reversible score). The IRA indication for revascularisation was evaluated by MDCT-jeopardised score plus CTA. SPECT-SRS >= 2 plus CCA-culprit lesion >= 50% was the standard reference. Results: The presence of MDCT-delayed enhancement was found in 101 (94.4%) patients. The IRA and culprit lesion were identified in 99 (92.5%) patients by MDCT-myocardium maps plus CTA. The concordance between MDCT and SPECT for detecting infarcted myocardium was good (kappa = 0.702). The correlation between MDCT-jeopardised score and SPECT-SRS was 0.741. The correlation between CTA and CCA for culprit lesion severity was 0.85. The sensitivity, specificity, negative and positive predictive values of MDCT-jeopardised score >= 2.5 plus CTA for indicating revascularisation were 90.2%, 80.4%, 86.0% and 85.9%, respectively. Conclusions: Dual-phase MDCT has good accuracy for identifying IRA, and assessing infarcted and jeopardised myocardium for clinical relevance. It provides an alternative for triage and therapeutic planning in post-AMI.
引用
收藏
页码：1495 / 1501
页数：7
相关论文
共 29 条
[1]   Assessment of left ventricular function with 16-and 64-slice multi-detector computed tomography [J].
Abbara, Suhny ;
Chow, Benjamin J. W. ;
Pena, Antonio J. ;
Cury, Ricardo C. ;
Hoffmann, Udo ;
Nieman, Koen ;
Brady, Thomas J. .
EUROPEAN JOURNAL OF RADIOLOGY, 2008, 67 (03) :481-486
[2]   ACC/AHA 2007 guide lines for the management of patients with unstable Angina/Non-ST-Elevation myocardial infraction - Executive summary [J].
Anderson, Jeffrey L. ;
Adams, Cynthia D. ;
Antman, Elliott M. ;
Bridges, Charles R. ;
Califf, Robert M. ;
Casey, Donald E., Jr. ;
Chavey, William E., II ;
Fesmire, Francis M. ;
Hochman, Judith S. ;
Levin, Thomas N. ;
Lincoff, A. Michael ;
Peterson, Eric D. ;
Theroux, Pierre ;
Wenger, Nanette Kass ;
Wright, R. Scott ;
Smith, Sidney C., Jr. ;
Jacobs, Alice K. ;
Adams, Cynthia D. ;
Riegel, Barbara .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2007, 50 (07) :652-726
[3]   ACC/AHA 2007 Guidelines for the Management of Patients With unstable Angina/Non-ST-Elevation Myocardial Infarction A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) Developed in Collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine [J].
Anderson, Jeffrey L. ;
Adams, Cynthia D. ;
Antman, Elliott M. ;
Bridges, Charles R. ;
Califf, Robert M. ;
Casey, Donald E., Jr. ;
Chavey, William E. ;
Fesmire, Francis M. ;
Hochman, Judith S. ;
Levin, Thomas N. ;
Lincoff, A. Michael ;
Peterson, Eric D. ;
Theroux, Pierre ;
Wenger, Nanette Kass ;
Wright, R. Scott ;
Smith, Sidney C. ;
Jacobs, Alice K. ;
Halperin, Jonathan L. ;
Hunt, Sharon A. ;
Krumholz, Harlan M. ;
Kushner, Frederick G. ;
Lytle, Bruce W. ;
Nishimura, Rick ;
Ornato, Joseph P. ;
Page, Richard L. ;
Riegel, Barbara .
CIRCULATION, 2007, 116 (07) :E148-E304
[4]   Culprit lesion and jeopardized myocardium: Correlation between coronary angiography and single-photon emission computed tomography [J].
CandellRiera, J ;
SantanaBoado, C ;
CastellConesa, J ;
AguadeBruix, S ;
OlonaCabases, M ;
Domingo, E ;
PermanyerMiralda, G ;
SolerSoler, J .
CLINICAL CARDIOLOGY, 1997, 20 (04) :345-350
[5]   Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart - A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association [J].
Cerqueira, MD ;
Weissman, NJ ;
Dilsizian, V ;
Jacobs, AK ;
Kaul, S ;
Laskey, WK ;
Pennell, DJ ;
Rumberger, JA ;
Ryan, T ;
Verani, MS .
CIRCULATION, 2002, 105 (04) :539-542
[6]   Identification and viability assessment of infarcted myocardium with late enhancement multidetector computed tomography: Comparison with thallium single photon emission computed tomography and echocardiography [J].
Chiou, Kuan-Rau ;
Liu, Chun-Peng ;
Peng, Nan-Jing ;
Huang, Wei-Chun ;
Hsiao, Shih-Hung ;
Huang, Yi-Luan ;
Chen, Kuen-Huang ;
Wu, Ming-Ting .
AMERICAN HEART JOURNAL, 2008, 155 (04) :738-745
[7]   Comparison of radiation doses from multislice computed tomography coronary angiography and conventional diagnostic angiography [J].
Coles, DR ;
Smail, MA ;
Negus, IS ;
Wilde, P ;
Oberhoff, M ;
Karsch, KR ;
Baumbach, A .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2006, 47 (09) :1840-1845
[8]   Prospectively gated transverse coronary CT angiography versus retrospectively gated helical technique: Improved image quality and reduced radiation dose [J].
Earls, James P. ;
Berman, Elise L. ;
Urban, Bruce A. ;
Curry, Charlene A. ;
Lane, Judith L. ;
Jennings, Robert S. ;
McCulloch, Colin C. ;
Hsieh, Jiang ;
Londt, John H. .
RADIOLOGY, 2008, 246 (03) :742-753
[9]   Radiation risk from coronary artery disease imaging: how do different diagnostic tests compare? [J].
Einstein, Andrew J. .
HEART, 2008, 94 (12) :1519-1521
[10]   Radiation dose to patients from cardiac diagnostic imaging [J].
Einstein, Andrew J. ;
Moser, Kevin W. ;
Thompson, Randall C. ;
Cerqueira, Manuel D. ;
Henzlova, Milena J. .
CIRCULATION, 2007, 116 (11) :1290-1305
123