Background- Although troponin elevation after percutaneous coronary intervention(PCI) is common, uncertainties remain about the mechanisms of its release and its relationship to the volume of myocardial tissue loss. D...Background- Although troponin elevation after percutaneous coronary intervention(PCI) is common, uncertainties remain about the mechanisms of its release and its relationship to the volume of myocardial tissue loss. Delayed- enhancement MRI of the heart has been shown to reliably quantify areas of irreversible myocardial injury. To investigate the quantitative relationship between irreversible injury and cardiac troponin release, we studied the incidence and extent of new irreversible injury in patients undergoing PCI and correlated it to postprocedural changes in cardiac troponin I. Methods and Results- Fifty patients undergoing PCI were studied with preprocedural and postprocedural(24 hours) delayed- enhancement MRI for assessment of new irreversible myocardial injury. Cardiac troponin I measurements were obtained before PCI and 24 hours after PCI. Of these 50 patients, 24 underwent a further third MRI scan at a median of 8 months after the procedure. Mean patient age was 64± 12 years. After the procedure, 14 patients(28% ) had evidence of new myocardial hyperenhancement, with a mean mass of 6.0± 5.8 g, or 5.0± 4.8% of total left ventricularmass. All of these patients had raised troponin I levels(range 1.0 to 9.4 μ g/L). Thirty- four patients(68% ) had no elevated troponin I and no evidence of new myocardial necrosis on MRI. There was a strong correlation between the rise in troponin I measurements at 24 hours and mean mass of new myocardial hyperenhancement, both early(r=0.84; P< 0.001)and late(r=0.71; P< 0.001) after PCI, although there was a trend for a reduction in the size of PCI- induced myocardial injury in the late follow- up scan(P=0.07). Conclusions- In the setting of PCI, patients demonstrating postprocedural elevation in troponin I have evidence of new irreversible myocardial injury on delayed- enhancement MRI. The magnitude of this injury correlates directly with the extent of troponin elevation.展开更多
文摘Background- Although troponin elevation after percutaneous coronary intervention(PCI) is common, uncertainties remain about the mechanisms of its release and its relationship to the volume of myocardial tissue loss. Delayed- enhancement MRI of the heart has been shown to reliably quantify areas of irreversible myocardial injury. To investigate the quantitative relationship between irreversible injury and cardiac troponin release, we studied the incidence and extent of new irreversible injury in patients undergoing PCI and correlated it to postprocedural changes in cardiac troponin I. Methods and Results- Fifty patients undergoing PCI were studied with preprocedural and postprocedural(24 hours) delayed- enhancement MRI for assessment of new irreversible myocardial injury. Cardiac troponin I measurements were obtained before PCI and 24 hours after PCI. Of these 50 patients, 24 underwent a further third MRI scan at a median of 8 months after the procedure. Mean patient age was 64± 12 years. After the procedure, 14 patients(28% ) had evidence of new myocardial hyperenhancement, with a mean mass of 6.0± 5.8 g, or 5.0± 4.8% of total left ventricularmass. All of these patients had raised troponin I levels(range 1.0 to 9.4 μ g/L). Thirty- four patients(68% ) had no elevated troponin I and no evidence of new myocardial necrosis on MRI. There was a strong correlation between the rise in troponin I measurements at 24 hours and mean mass of new myocardial hyperenhancement, both early(r=0.84; P< 0.001)and late(r=0.71; P< 0.001) after PCI, although there was a trend for a reduction in the size of PCI- induced myocardial injury in the late follow- up scan(P=0.07). Conclusions- In the setting of PCI, patients demonstrating postprocedural elevation in troponin I have evidence of new irreversible myocardial injury on delayed- enhancement MRI. The magnitude of this injury correlates directly with the extent of troponin elevation.
文摘宫腔粘连(intrauterine adhesions,IUA)是指因感染、有创性宫腔诊疗操作等因素造成子宫内膜基底层不可逆损伤,从而导致的不同程度的宫腔和子宫颈管粘连。IUA的患者常常表现为月经量减少、继发性闭经等,严重者生育力下降,导致不孕、自然流产、胎盘异常等,极大地危害了育龄期女性的身心健康。IUA患者如有生育需求,一般建议首先选择宫腔镜下宫腔粘连分离术(transcervical resection of adhesion,TCRA)以尽可能恢复子宫正常形态、容积及功能,这也是目前治疗IUA最常用的方法。然而,TCRA后再粘连率高达30%~62.5%,且术后妊娠率较低,妊娠成功率仅22.5%~33.3%[1]。因此,为预防IUA复发并改善生殖预后,TCRA后及时采取适宜的子宫内膜修复措施至关重要。
