学位論文の要約
所 属
三重大学大学院医学系研究科 甲 生命医科学専攻 臨床医学系講座
循環器 ・ 腎臓内科学分野
氏 名
ー 重 大 学
実誤伝
主論文の題名
Prognostic impact of unrecognized myocardial scar in the non-culprit territories by cardiac magnetic resonance imaging in patients with acute myocardial infarction
初発急性心筋梗塞患者における偶発的に発見された非責任梗塞領域の遅延造影 が予後に与える影響
Taku Omori, Tairo Kurita, Kaoru Dohi, Akihiro Takasaki,
Tomoyuki Nakata, Shiro Nakamori, Naoki Fujimoto, Kakuya Kitagawa, Kozo, Hoshino, Takashi Tanigawa, Hajime Sakuma, and Masaaki Ito,
European Heart Journal - Cardiovascular Imaging (2017) 00, l ·9 Published : July 27, 2017
doi: 10.1093/ehjci/jexl94
主論文の要約
(Background)
Unrecognized myocardial scar detected by late gadolinium enhancement (LGE) magnetic resonance imaging (MRI) is strongly associated with cardiac event in patients with stable coronary artery disease. However, the prognostic value of LGE in the territories of non-culprit coronary arteries in patients with acute myocardial infarction (AMI) remains unknown. The purpose of this study was to evaluate the prognostic impact of unrecognized non·infarct·related LGE (non·IR·LGE) in patients with AMI.
(Methods)
We studied 269 patients with a first clinical episode of AMI who underwent cardiac MRI within 6 weeks after onset (209 men; age, 66土 12years). LGE, cine MRI and T2‑weighted imaging were obtained to evaluate the presence and extent of LGE and to evaluate cardiac function. Major adverse cardiac events (MACE) were defined as cardiovascular death, non‑fatal AMI, unstable angina requiring revascularization, fatal arrhythmia and hospitalization for heart failure. The Cox proportional hazards model was used to investigate the relationship between clinical, a'ngiographic and MRI variables, and MACE.
(Results)
Unrec~gnized non‑IR‑LGE was observed in 13.0% of patients. During follow‑up periods (median, 22 months; range, 3 to 95 months), 8.9% of patients experienced MACE in this study. In addition, 22.9% of patients with unrecognized non‑IR‑LGE and 6.8% of patients without unrecognized non‑IR‑LGE experienced MACE (Pく0.01). Presence of unrecognized non‑IR‑LGE predicted MACE with a hazard ratio of 3.45 (95% Confidential interval, 1.03 to 11.4 7; Pく0.01). By the Cox proportional hazards model, unrecognized non‑IR‑LGE, age and left ventricular end‑diastolic volume index were independent predictors of MACE (Pく0.01,respectively). In contrast, angiography‑proven multi‑vessel disease and transmural extent of infarct‑related LGE were not independently associated with MACE.
(Conclusions)
Among patients with a first clinical episode of AMI, unrecognized non‑IR‑LGE provides incremental prognostic value for predicting MACE beyond that of common clinical, angiographic and functional variables.
