慢性完全闭塞的心肌存活率和缺血
Myocardial Viability and Ischaemia in Chronic Total Occlusion.
摘要(中文译文)
慢性完全闭塞（CTO）影响30%接受冠状动脉造影的患者，并导致较差的预后。虽然经皮冠状动脉介入治疗（PCI）在技术上可以成功，但随机对照试验（RCT）显示无生存获益。心血管磁共振（CMR）提供全面的心肌表型分析，为该高危人群提供预后信息。56例经血管造影确诊的CTO患者接受了负荷灌注CMR及延迟钆增强检查。对心肌功能、缺血和瘢痕负荷进行量化，并在CTO供血区域和存活心肌亚组之间进行比较。在CTO患者中，27%的患者（15/56）无存活心肌。在存活心肌患者中，66%（27/41）表现出可逆性缺血。存活心肌与显著较高的左心室每搏输出量相关（93.6 ± 20.1 mL vs. 80.9 ± 18.4 mL，= 0.039），同时左心室瘢痕质量较低（18.7 ± 13.5g vs. 32.3 ± 12.8g；= 0.002），瘢痕百分比较低（14.9 ± 8.3% vs. 25.9 ± 7.5%；= 0.001）。存活心肌在整体（11.6 ± 14.3g vs. 0.2 ± 9.3g；= 0.005）和CTO供血区域内（10.3 ± 10.3% vs. 2.3 ± 2.7%；= 0.01）均表现出更多缺血。无存活心肌与显著较高的CTO区域瘢痕质量相关（9.4 ± 6.5 g vs. 5.1 ± 6.9 g；= 0.046）及瘢痕百分比（21.8 ± 13.3% vs. 11.7 ± 12.8%；= 0.01），提示广泛纤维化。CTO区域瘢痕负荷阈值为11.18%时，预测无存活心肌的敏感性为80%，特异性为65.85%（AUC = 0.701 [95% CI 0.54-0.87]，= 0.019）。在CTO患者中，27%无存活心肌，而存活心肌患者通常表现为可逆性缺血——代表一种存活心肌保留合并可诱导缺血的表型。这些发现支持在考虑CTO-PCI之前使用多参数CMR对CTO区域进行表型分析。
Abstract
Chronic total occlusion (CTO) affects 30% of patients undergoing coronary angiography rendering poorer outcomes. While percutaneous coronary intervention (PCI) can be technically successful, RCTs show no survival benefit. Cardiovascular Magnetic Resonance (CMR) provides comprehensive myocardial phenotyping, offering prognostic insights in this high-risk cohort. Fifty-six patients with angiographically confirmed CTO underwent stress perfusion CMR with late gadolinium enhancement. Myocardial function, ischaemia and scar burden were quantified and compared across CTO territory and viability subgroups. : In patients with CTO, 27% of patients (15/56) had no viability. In patients with viable myocardium, 66% (27/41) demonstrated reversible ischaemia. Viable myocardium was associated with significantly higher LV stroke volumes (93.6 ± 20.1 mL vs. 80.9 ± 18.4 mL, = 0.039), along with lower LV scar mass (18.7 ± 13.5g vs. 32.3 ± 12.8g; = 0.002) and scar percentage (14.9 ± 8.3% vs. 25.9 ± 7.5%; = 0.001). Viable myocardium showed more ischaemia both globally (11.6 ± 14.3g vs. 0.2 ± 9.3g; = 0.005) and within the CTO territory (10.3 ± 10.3% vs. 2.3 ± 2.7%; = 0.01). Non-viable myocardium was associated with significantly higher CTO-territory scar mass (9.4 ± 6.5 g vs. 5.1 ± 6.9 g; = 0.046) and scar percentage (21.8 ± 13.3% vs. 11.7 ± 12.8%; = 0.01), indicating extensive fibrosis. A scar burden threshold of 11.18% in CTO territory predicted non-viability with 80% sensitivity and 65.85% specificity (AUC = 0.701 [95% CI 0.54-0.87], = 0.019). Among CTO patients, 27% harbour no viability, while patients with viable myocardium typically exhibit reversible ischaemia-representing a phenotype with preserved viability and inducible ischaemia. These findings support the use of multiparametric CMR to phenotype CTO territories prior to considering CTO-PCI.
如何引用
AMA
Zia Mehmood, Preethi Suresh, Rui Li, Hosamadin Assadi, Bahman Kasmai, Kurian Thampi, et al. Myocardial Viability and Ischaemia in Chronic Total Occlusion.. Medicina (Kaunas, Lithuania). 2026; doi:10.3390/medicina62030540.
APA
Zia Mehmood, Preethi Suresh, Rui Li, Hosamadin Assadi, Bahman Kasmai, Kurian Thampi, et al (2026). Myocardial Viability and Ischaemia in Chronic Total Occlusion.. Medicina (Kaunas, Lithuania). https://doi.org/10.3390/medicina62030540
GB/T 7714
Zia Mehmood, Preethi Suresh, Rui Li, Hosamadin Assadi, Bahman Kasmai, Kurian Thampi, et al. Myocardial Viability and Ischaemia in Chronic Total Occlusion.[J]. Medicina (Kaunas, Lithuania), 2026 doi:10.3390/medicina62030540.
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