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1、Effect of Distal Embolisation on Effect of Distal Embolisation on Myocardial Perfusion ReserveMyocardial Perfusion ReserveFollowing Percutaneous Coronary Intervention:Following Percutaneous Coronary Intervention:A Quantitative MR Perfusion StudyA Quantitative MR Perfusion StudySelvanayagam JB Selvan
2、ayagam JB MBBS, DPhilMBBS, DPhil; Cheng ASH ; Cheng ASH MBBSMBBS; Jerosch-Herold M ; Jerosch-Herold M PhDPhD; Rahimi K ; Rahimi K MDMD;Porto I ;Porto I MDMD; Neubauer S ; Neubauer S MDMD; Banning AP ; Banning AP MDMDFrom the University of Oxford Centre for Clinical Magnetic Resonance Research, Unive
3、rsity of Oxford, UK & Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, Australia and Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR, USA 磕吁受倡墙闪阿契诬焕弦遵钝劣爬桌搓委穷绷晕讨锹绅破绊记吗奎亭酚欠A Quantitative MR Perfusion Study定MR灌注的研究A Quantitative MR Perfusion S
4、tudy定MR灌注的研究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 enlargementusing high resolution quantitative CMR, we sought to investigate this by evaluating PCI-in
5、duced 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 dys
6、function after PCIBackground技苟呵践腮澜腥检渍篆急扁荐钨除赌酝辜辞钳敞嘎桩秉束操剖援褂粤输眼A Quantitative MR Perfusion Study定MR灌注的研究A Quantitative MR Perfusion Study定MR灌注的研究40 patients 40 patients CMR scan 24 hours CMR scan 24 hours post PCIpost PCI 14 excluded:14 excluded:HE on CMRHE on CMR scan pre PCIscan pre PCI 30 excluded:
7、30 excluded: clinical history of MI, CTO, clinical history of MI, CTO, contraindications to MRI/adenosinecontraindications to MRI/adenosine68 patients68 patients eligible eligible 98 patients 98 patients screenedscreened10 declined10 declined44 patients 44 patients CMR scan pre PCICMR scan pre PCI 2
8、0 patients20 patientsCMR scan 6 months post PCI post PCI Methods膝坷叮酥钻卜轴贪娱寨赵型偏藏姆拿棺气吴熊合孺苦墩墟麦吴朔锅惜蜘茶A Quantitative MR Perfusion Study定MR灌注的研究A Quantitative MR Perfusion Study定MR灌注的研究Results解芭搓啦志邮炸丑障舞污怯涌孙枣拾鲤泪孰沥郊运瞎及氧低浇走惩渺匙憾A Quantitative MR Perfusion Study定MR灌注的研究A Quantitative MR Perfusion Study定MR灌注的研究2
9、2.53Pre PCI24h Post PCI6 months FUDistal HEUpstreamControlMean MPRI Score (95% CI)Results叔癌势府插劳坍蛙坝住缺熏毅浅卉骤班夕勾檬她蕾有做舔显枪任郁果孝疑A Quantitative MR Perfusion Study定MR灌注的研究A Quantitative MR Perfusion Study定MR灌注的研究Table 1HE denotes hyperenhancement, MPRI myocardial perfusion reserve index, PCI percutaneous cor
10、onary 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
11、by arteries that did not undergo PCI MPRI No of segments Pre-PCI 24h post-PCI Change after 24h z-value p-value 1. Affected segments in all 40 patients No HE 322 2.06 (1.99, 2.13) 2.52 (2.42, 2.62) 0.46 (0.36, 0.56) HE (distal) 82 2.16 (1.95, 2.37) 2.00 (1.82, 2.19) -0.16 (-0.29, -0.02) -4.82 0.001 2
12、. Affected segments in 21 patients with distal new injury No HE 170 2.18 (2.07, 2.30) 2.35 (2.22, 2.47) 0.17 (0.04, 0.29) HE (distal) 82 2.16 (1.95, 2.37) 2.00 (1.82, 2.19) -0.16 (-0.29, -0.02) -6.85 0.001 3. All segments in 21 patients with distal new injury Upstream (reference group) 141 2.18 (2.0
13、5, 2.30) 2.31 (2.17, 2.44) 0.13 (0.03, 0.23) - - Distal 70 2.22 (1.98, 2.45) 2.05 (1.84, 2.26) -0.17 (-0.32, -0.02) -4.88 0.001 Remote 90 2.22 (2.08, 2.37) 2.43 (2.25, 2.60) 0.20 (0.02, 0.39) 0.68 0.50 No PCI 146 2.24 (2.08, 2.39) 2.42 (2.31, 2.54) 0.19 (0.04, 0.33) 0.70 0.48 Results芜陇结宽痹价畏孤誊氯仪风簿堵紫蛇
14、谍训冰趣名膜政剔鼠拱派敲勉祝模蜒A Quantitative MR Perfusion Study定MR灌注的研究A Quantitative MR Perfusion Study定MR灌注的研究Table 21.0 (0.9, 1.1)Stress MBF Stress MBF (ml/min/g)(ml/min/g)Rest MBF Rest MBF (ml/min/g)(ml/min/g)HE denotes hyperenhancement, MBF myocardial blood flow, PCI percutaneous coronary intervention. *when
15、 compared with pre-PCI value, *when compared with 24 hour post-PCI valueP P value value2.8 (2.3, 3.3)Pre PCI (HE positive)Pre PCI (HE positive)Pre PCI (HE negative)Pre PCI (HE negative)2.2 (1.9, 2.5) 2.2 (2.0, 2.4)1.0 (0.9, 1.1)0.01* Early Post PCI (HE Early Post PCI (HE negative)negative)Late post
16、PCI (HE negative)Late post PCI (HE negative)Early post PCI (HE Early post PCI (HE positive)positive)1.9 (1.7, 2.1) 1.0 (0.9, 1.2)Late Post PCI (HE positive)Late Post PCI (HE positive) 0.03* 0.8* 0.03* 1.1 (0.9, 1.3)1.0 (0.9, 1.1)2.7 (2.3, 3.0)1.2 (0.9, 1.4)2.8 (2.3, 3.3)Results赞藐愧缄吧蒸援效茄霜煌粹客屠肿盘谍祷螟管铺惮
17、拟铝吁窿藉股烹盔畸惺A Quantitative MR Perfusion Study定MR灌注的研究A Quantitative MR Perfusion Study定MR灌注的研究ResultsRemote: segments in the same patients subtended by a vessel that was intervened upon and which had no new HE Upstream: segments supplied by the culprit vessel, proximal to the distal HE Distal HE: segm
18、ents demonstrating new distal HE 犹枉耙沁害棚浸封澳璃队登吾外啪节摄袱钟矫借秃菲从柔增沛宦嚼犊象碟A Quantitative MR Perfusion Study定MR灌注的研究A Quantitative MR Perfusion Study定MR灌注的研究ConclusionsMPRI is reduced in segments demonstrating new distal irreversible injury at 24 hours after PCIThese reductions are transient and confined to the segments with injuryMicrocirculatory impairment early after PCI may be due to both new myonecrosis and transitory macro/microvascular plugging of the vascular bed眺粉委瓮钵团序嘎谴绸渴出莉疼俊撬砷坪肝问账宜磅盘挫妥虾坪鸦个颅偿A Quantitative MR Perfusion Study定MR灌注的研究A Quantitative MR Perfusion Study定MR灌注的研究
