Клиническо-диагностическое значение экстрацеллюлярного объема в разные периоды инфаркта миокарда левого желудочка

Олейников В.Э., Вдовкин А.В., Донецкая Н.А., Салямова Л.И., Чернова А.А. Клиническо-диагностическое значение экстрацеллюлярного объема в разные периоды инфаркта миокарда левого желудочка. Терапевтический архив. 2026;98(4):231–236. DOI: 10.26442/00403660.2026.04.203577

© ООО «КОНСИЛИУМ МЕДИКУМ», 2026 г.

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Oleynikov VE, Vdovkin АV, Donetskaya NА, Salyamova LI, Chernova AA. Clinical and diagnostic significance of extracellular volume in different periods of left ventricular myocardial infarction. A review. Terapevticheskii Arkhiv (Ter. Arkh.). 2026;98(4):231–236. DOI: 10.26442/00403660.2026.04.203577

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Аннотация

В обзоре представлены данные о патофизиологических процессах, отражающихся на объеме внеклеточного пространства (Extracellular Volume – ECV) в остром и хроническом периодах инфаркта миокарда. Обсуждается влияние совокупности острых повреждений миокарда на повышение ECV, что делает его мощным независимым предиктором неблагоприятного ремоделирования левого желудочка, риска серьезных сердечно-сосудистых событий и аритмий. Представлены актуальные методики оценки ECV. Показано, что, несмотря на ограничения, связанные с неспецифичностью и необходимостью стандартизации методик, ECV-картирование превосходит традиционные подходы в оценке размера инфаркта и стратификации риска, открывая пути для индивидуального контроля эффективности лечения. Обзор охватывает как фундаментальные валидационные работы, так и новейшие исследования, посвященные патофизиологическому обоснованию метода, методическим аспектам реализации, клиническим подходам, посвященным изучению ECV, в том числе для оценки антиремоделирующей терапии.

Ключевые слова: инфаркт миокарда, объем внеклеточного пространства, магнитно-резонансная томография сердца, компьютерная томография сердца

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This review examines the pathophysiological processes affecting the Extracellular Volume (ECV) in both the acute and chronic phases of myocardial infarction. It discusses how the constellation of acute myocardial injuries leads to ECV expansion, establishing it as a robust and independent predictor of adverse left ventricular remodeling, major adverse cardiovascular events, and arrhythmic risk. The review outlines current methodologies for ECV assessment. It is shown that despite limitations related to its non-specific nature and the need for protocol standardization, ECV mapping surpasses traditional approaches in infarct size quantification and risk stratification, paving the way for personalized monitoring of treatment efficacy. The review encompasses foundational validation studies as well as recent research focused on the pathophysiological rationale of the method, technical aspects of its implementation, and clinical applications of ECV analysis, including its role in evaluating anti-remodeling therapies.

Keywords: myocardial infarction, extracellular volume, cardiac magnetic resonance, cardiac computed tomography

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1. Frantz S, Hundertmark MJ, Schulz-Menger J, et al. Left ventricular remodelling post-myocardial infarction: pathophysiology, imaging, and novel therapies. Eur Heart J. 2022;43(27):2549-61. DOI:10.1093/eurheartj/ehac223
2. Xu B, Li W, You Z, et al. Risk factors for left ventricular remodeling after myocardial infarction: A meta-analysis. Medicine (Baltimore). 2024;103(46):e40496. DOI:10.1097/MD.0000000000040496
3. Frangogiannis NG. Cardiac fibrosis. Cardiovasc Res. 2021;117(6):1450-88. DOI:10.1093/cvr/cvaa324
4. Chen L, Qiu B, Du X, et al. Establishment of a synthetic ECV model and its prognostic value in diabetes patients with acute myocardial infarction. Front Endocrinol. 2025;16:1534236. DOI:10.3389/fendo.2025.1534236
5. Martuszewski A, Paluszkiewicz P, Poręba R, et al. Clinical Significance of Extracellular Volume of Myocardium (ECV) Assessed by Computed Tomography: A Systematic Review and Meta-Analysis. J Clin Med. 2025;14(6):2066. DOI:10.3390/jcm14062066
6. Zhu GJ, Qureshi S, Hedges W, et al. Cardiac ECV mapping: Underlying concepts and clinical applications. Meta-Radiology. 2025;3:100168. DOI:10.1016/j.metrad.2025.100168
7. Cundari G, Galea N, Mergen V, et al. Myocardial extracellular volume quantification with computed tomography-current status and future outlook. Insights Imaging. 2023;14(1):156. DOI:10.1186/s13244-023-01506-6
8. Matusik PS, Mikrut K, Bryll A, et al. Cardiac Magnetic Resonance Imaging in Diagnostics and Cardiovascular Risk Assessment. Diagnostics (Basel). 2025;15(2):178. DOI:10.3390/diagnostics15020178
9. Stoeck CT, von Deuster C, Fuetterer M, et al. Cardiovascular magnetic resonance imaging of functional and microstructural changes of the heart in a longitudinal pig model of acute to chronic myocardial infarction. J Cardiovasc Magn Reson. 2021;23(1):103. DOI:10.1186/s12968-021-00794-5
10. Zhang SJ, Chang D, Jin JY, et al. Myocardial Extracellular Volume Fraction Measured by Cardiac Magnetic Resonance Imaging Negatively Correlates With Cardiomyocyte Breadth in a Healthy Porcine Model. Front Cardiovasc Med. 2022;9:791963. DOI:10.3389/fcvm.2022.791963
11. Buck KM, Rogers HT, Gregorich ZR, et al. Extracellular matrix alterations in chronic ischemic cardiomyopathy revealed by quantitative proteomics. JCI Insight. 2025;10(21):e196933. DOI:10.1172/jci.insight.196933
12. Gunata M, Parlakpinar H. A review of myocardial ischaemia/reperfusion injury: Pathophysiology, experimental models, biomarkers, genetics and pharmacological treatment. Cell Biochem Funct. 2021;39(2):190-217. DOI:10.1002/cbf.3587
13. Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J Acute Cardiovasc Care. 2024;13(1):55-161. DOI:10.1093/ehjacc/zuad107
14. Yong J, Tao J, Wang K, et al. Post-myocardial Infarction Cardiac Remodeling: Multidimensional Mechanisms and Clinical Prospects of Stem Cell Therapy. Stem Cell Rev Rep. 2025;21(5):1369-427. DOI:10.1007/s12015-025-10888-7
15. Ma Y. Role of Neutrophils in Cardiac Injury and Repair Following Myocardial Infarction. Cells. 2021;10(7):1676. DOI:10.3390/cells10071676
16. Yang Z, Zhang Z, Feng S, et al. Cross-talk between cardiac lymphatics and immune cells regulates inflammatory response and cardiac recovery after myocardial infarction. Front Immunol. 2025;16:1557250. DOI:10.3389/fimmu.2025.1557250
17. Ren LL, Miao H, Wang YN, et al. TGF-β as A Master Regulator of Aging-Associated Tissue Fibrosis. Aging Dis. 2023;14(5):1633-50. DOI:10.14336/AD.2023.0222
18. Umbarkar P, Ejantkar S, Tousif S, et al. Mechanisms of Fibroblast Activation and Myocardial Fibrosis: Lessons Learned from FB-Specific Conditional Mouse Models. Cells. 2021;10(9):2412. DOI:10.3390/cells10092412
19. Poddi S, Lefter CL, Linardi D, et al. Myocardial Fibrosis: Assessment, Quantification, Prognostic Signification, and Anti-Fibrosis Targets: A State-of-the-Art Review. J Cardiovasc Dev Dis. 2025;12(5):192. DOI:10.3390/jcdd12050192
20. De Meester de Ravenstein C, Bouzin C, Lazam S, et al. Histological Validation of measurement of diffuse interstitial myocardial fibrosis by myocardial extravascular volume fraction from Modified Look-Locker imaging (MOLLI) T1 mapping at 3T. J Cardiovasc Magn Reson. 2015;17(1):48. DOI:10.1186/s12968-015-0150-0
21. Messroghli DR, Moon JC, Ferreira VM, et al. Clinical recommendations for cardiovascular magnetic resonance mapping of T1, T2, T2* and extracellular volume: A consensus statement by the Society for Cardiovascular Magnetic Resonance (SCMR) endorsed by the European Association for Cardiovascular Imaging (EACVI). J Cardiovasc Magn Reson. 2017;19(1):75. DOI:10.1186/s12968-017-0389-8
22. Ishiyama M, Kurita T, Nakamura S, et al. Prognostic importance of acute phase extracellular volume evaluated by cardiac magnetic resonance imaging for patients with acute myocardial infarction. Int J Cardiovasc Imaging. 2021;37(11):3285-97. DOI:10.1007/s10554-021-02321-0
23. Chen H, Erley J, Muellerleile K, et al. Contrast-enhanced cardiac MRI is superior to non-contrast mapping to predict left ventricular remodeling at 6 months after acute myocardial infarction. Eur Radiol. 2024;34(3):1863-74. DOI:10.1007/s00330-023-10100-9
24. Calvieri C, Riva A, Sturla F, et al. Left Ventricular Adverse Remodeling in Ischemic Heart Disease: Emerging Cardiac Magnetic Resonance Imaging Biomarkers. J Clin Med. 2023;12(1):334. DOI:10.3390/jcm12010334
25. Ralota KK, Layland J, Han Win KT, et al. Myocardial Viability: Evolving Insights and Challenges in Revascularization and Functional Recovery. J Cardiovasc Dev Dis. 2025;12(3):106. DOI:10.3390/jcdd12030106
26. Garg P, Broadbent DA, Swoboda PP, et al. Acute Infarct Extracellular Volume Mapping to Quantify Myocardial Area at Risk and Chronic Infarct Size on Cardiovascular Magnetic Resonance Imaging. Circ Cardiovasc Imaging. 2017;10(7):e006182. DOI:10.1161/CIRCIMAGING.117.006182
27. Segre CAW, de Lemos JA, Assunção Junior AN, et al. Chronic troponin elevation assessed by myocardial T1 mapping in patients with stable coronary artery disease. Medicine (Baltimore). 2023;102(16):e33548. DOI:10.1097/MD.0000000000033548
28. Kato S, Misumi Y, Horita N, et al. Clinical Utility of Computed Tomography-Derived Myocardial Extracellular Volume Fraction: A Systematic Review and Meta-Analysis. JACC Cardiovasc Imaging. 2024;17(5):516-28. DOI:10.1016/j.jcmg.2023.10.008
29. Black N, Bradley J, Schelbert EB, Bonnett LJ, et al. Remote myocardial fibrosis predicts adverse outcome in patients with myocardial infarction on clinical cardiovascular magnetic resonance imaging. J Cardiovasc Magn Reson. 2024;26(2):101064. DOI:10.1016/j.jocmr.2024.101064
30. Liang K, Nakou E, Del Buono MG, et al. The Role of Cardiac Magnetic Resonance in Myocardial Infarction and Non-obstructive Coronary Arteries. Front Cardiovasc Med. 2022;8:821067. DOI:10.3389/fcvm.2021.821067
31. Cadour F, Quemeneur M, Biere L, et al. Prognostic value of cardiovascular magnetic resonance T1 mapping and extracellular volume fraction in nonischemic dilated cardiomyopathy. J Cardiovasc Magn Reson. 2023;25(1):7. DOI:10.1186/s12968-023-00919-y
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Авторы

В.Э. Олейников*¹, А.В. Вдовкин², Н.А. Донецкая², Л.И. Салямова¹, А.А. Чернова¹

¹ФГБОУ ВО «Пензенский государственный университет», Пенза, Россия;
²ГБУЗ «Пензенская областная клиническая больница им. Н.Н. Бурденко», Пенза, Россия
*v.oleynikof@gmail.com

________________________________________________

Valentin E. Oleynikov*¹, Alexandr V. Vdovkin², Natalia A. Donetskaya², Ludmila I. Salyamova¹, Angelina A. Chernova¹

¹Penza State University, Penza, Russia;
²Burdenko Penza Regional Clinical Hospital, Penza, Russia
*v.oleynikof@gmail.com

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