磁共振评价急性心肌梗死患者心肌活性的临床意义及与内皮素的相关性

Magnetic resonance perfusion imaging for assessment of correlation between myocardial activity and endothelin in acute myocardial infarction

目的对临床上确诊为急性心肌梗死的患者，行磁共振检测，预测心肌梗死患者的心肌活性，并分析其与内皮素的相关性。方法选择急性心肌梗死患者19例，采用磁共振技术对心肌梗死患者心肌活性进行评价。对心肌梗死患者经皮冠状动脉介）k（PCI）术前3～5d、术后13个月分别行磁共振检查，分析心肌活性改善情况，对治疗的效果作出评价。同时采静脉血检测内皮素，观察其与磁共振检测结果的相关性。结果19例心肌梗死患者治疗后13个月的内皮素水平较术前所测值明显减低（P（0．01），左室射血分数（LVEF）较术前的数值有明显改善（P〈0．05）。结论检测血浆内皮素对预测心肌活性、评估冠状动脉缺血严重程度及判断预后具有一定的临床意义。磁共振灌注技术可以有效地检测心肌梗死的存活和非存活心肌，及其梗死程度和范围，对临床治疗及评估预后具有较为重要的临床意义。

Objective To determine the correlation between myocardial activity and endothelin by conducting magnetic resonance perfusion imaging in patients with clinically diagnosed acute myocardial infarction （AMI）. Methods Nineteen patients with AMI were allocated to be subjected to magnetic resonance perfusion imaging for assess ment of myocardial activity. Changes in myocardial activity were determined by comparison on the magnetic resonance perfusion imaging conducted at days 3-5 preoperatively and 13 months postoperatively in patients scheduled for per- cutaneous coronary intervention （PCI）. This was accompanied by sampling of the venous blood that entailed subse- quent assessment of the level of ET, thus allowing analysis on the correlation with the results derived from magnetic resonance perfusion imaging. Results Of 19 patients with myocardial infarction, treatment with PCI resulted in markedly reduced level of ET at month 13 preoperatively （P〈0.01）. Meanwhile, the treatment group yielded a signifi- cant improvement （P〈0.05） in left ventricular ejection fraction （LVEF）. Conclusion Detection of plasma ET may shed light on predicting the myocardial activity, disease severity and prognosis. Magnetic resonance perfusion imaging may effectively discriminate the survived and mortal myocardium as well as the extent and size of infarction.