磁共振评价冠状动脉非阻塞型心肌梗死的应用价值

王晓琰; 郭久红; 肖华; 陶晓峰

doi:10.12125/j.chj.201906043

磁共振评价冠状动脉非阻塞型心肌梗死的应用价值

Diagnostic value of cardiac magnetic resonance in patients with myocardial infarction with non-obstructive coronary arteries

摘要

摘要:
目的冠状动脉非阻塞性心肌梗死（MINOCA）是一种潜在多病因综合征，心脏磁共振（CMR）可以寻找MINOCA潜在的发病原因，本文旨在探讨CMR在MINOCA病因诊断和鉴别诊断中的价值。
方法回顾性研究2017年~2019年26例急性胸痛伴血肌钙蛋白升高的患者，冠状动脉造影未见明显阻塞或狭窄<50%，临床诊断为MINOCA。所有患者冠状动脉造影后行CMR扫描，分析磁共振图像特点，观察心脏结构、功能及有无灌注异常和延迟强化。
结果 26例MINOCA中CMR诊断心肌梗死15例（58%）、心肌炎3例（12%）、Takotsubo心肌病3例（12%），有4例（15%）CMR检查未见明显异常，1例（4%）无法明确具体病因，根据磁共振特征归为非缺血性心肌病。CMR最终确诊26例MINOCA中21例，诊断率81%。
结论 CMR一站式成像对于诊断MINOCA有独特作用，能够鉴别心肌炎、Takotsubo心肌病与急性心肌梗死等不同病因引起的MINOCA。

Abstract:
AIM To investigate the diagnostic value of cardiovascular magnetic resonance (CMR) imaging in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA).
METHODS From 2017 to 2019, 26 patients whose coronary angiography results did not show <50% stenosis in any of their coronary arteries underwent CMR imaging.
RESULTS CMR diagnoses included acute myocardial infarction (15 cases), acute myocarditis (3 cases) and Takotsubo cardiomyopathy (3 cases). The remaining patients (5 cases) had either nonspecific findings or could not be classified.
CONCLUSION One-stop CMR allows for etiological identification in most of the patients in this study. CMR imaging may help to differentiate MINOCA with acute myocardial infarction, Takotsubo cardiomyopathy or myocarditis.

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