评估心肌梗死患者的心肌生存力对于确定功能减弱区域的残余缺血组织以及确定是否需要进行血运重建至关重要。我们介绍了一名80岁的男性,患有胸痛和高血压病史。初步评估显示心电图异常,随后的研究表明,慢性前隔心肌梗死具有降低的心脏功能。进行了双能量心脏计算机断层扫描以评估冠状动脉和心肌。通过双能计算机断层扫描获得的晚期碘增强图像显示混合斑块和严重的左前降支近端狭窄。常规晚期碘增强成像尚无定论,提示使用碘密度成像进行细胞外体积分数分析。细胞外体积分数评估显示有活力的前心肌,导致成功的冠状动脉血运重建。随访显示壁运动和射血分数改善。我们的研究强调了双能量计算机断层扫描的晚期碘增强在评估心肌生存力作为磁共振成像的非侵入性替代方法中的实用性。尤其是有磁共振成像禁忌症的患者。这种方法有助于治疗计划,缺血性心脏病患者的疗效评估和预后判断。
Assessment of myocardial viability in patients with myocardial infarction is critical to identify residual ischemic tissue in areas of reduced function and to determine the need for revascularization. We present the
case of an 80-year-old man with chest pain and a history of hypertension. Initial evaluation revealed abnormal electrocardiogram findings, and subsequent studies suggested chronic anteroseptal myocardial infarction with reduced cardiac function. Dual-energy cardiac computed tomography was performed to evaluate the coronary arteries and myocardium. Late iodine enhancement images obtained by dual-energy computed tomography showed mixed plaques and severe proximal left anterior descending artery stenosis. Conventional late iodine enhancement imaging was inconclusive, prompting extracellular volume fraction analysis using iodine density imaging. Extracellular volume fraction assessment indicated viable anterior myocardium, leading to successful coronary revascularization. Follow-up demonstrated improved wall motion and ejection fraction. Our study highlights the utility of late iodine enhancement with dual-energy computed tomography in assessing myocardial viability as a noninvasive alternative to magnetic resonance imaging, particularly in patients with contraindications to magnetic resonance imaging. This approach aids in treatment planning, evaluation of efficacy and determination of prognosis in cases of ischemic heart disease.