A Quantitative MR Perfusion Study定量MR灌注的研究.pptVIP

Effect of Distal Embolisation on Myocardial Perfusion Reserve Following Percutaneous Coronary Intervention: A Quantitative MR Perfusion Study Selvanayagam JB MBBS, DPhil; Cheng ASH MBBS; Jerosch-Herold M PhD; Rahimi K MD;Porto I MD; Neubauer S MD; Banning AP MD From the University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, UK Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, Australia and Advanced Imaging Research Center, Oregon Health Science University, Portland, OR, USA Studies using intra-coronary Doppler have shown that a proportion of patients demonstrate persistent impairment in microcirculatory function after PCI, even after substantial conduit area enlargement using high resolution quantitative CMR, we sought to investigate this by evaluating PCI-induced changes in myocardial perfusion reserve index (MPRI) and procedure-related myonecrosis HYPOTHESES MPRI is impaired in segments with new ‘distal’ PCI-induced injury myocardial segments ‘upstream’ to the injury in the territory of the culprit vessel would not demonstrate persistent microvascular dysfunction after PCI Background 40 patients CMR scan 24 hours post PCI 14 excluded: HE on CMR scan pre PCI 30 excluded: clinical history of MI, CTO, contraindications to MRI/adenosine 68 patients eligible 98 patients screened 10 declined 44 patients CMR scan pre PCI 20 patients CMR scan 6 months post PCI Methods Results 2 2 . 5 3 Pre PCI 24h Post PCI 6 months FU Distal HE Upstream Control Mean MPRI Score (95% CI) Results Table 1 HE denotes hyperenhancement, MPRI myocardial perfusion reserve index, PCI percutaneous coronary intervention. Upstream=myocardial segments supplied by the culprit vessel proximal to the distal HE; Remote=segments that underwent PCI in a second vessel in the same patients but not displaying new injury; distal HE=segments demonstrating new distal injury; No PCI=Segments that are subtended by arteries that