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Myocardium at risk after acute infarction in humans on cardiac magnetic resonance: quantitative assessment during follow-up and validation with single-photon emission computed tomography.

Carlsson, Marcus LU ; Ubachs, Joey LU ; Hedström, Erik LU ; Heiberg, Einar LU ; Jovinge, Stefan LU and Arheden, Håkan LU (2009) In JACC: Cardiovascular Imaging 2(5). p.569-576
Abstract
OBJECTIVES: Our goal was to validate myocardium at risk on T2-weighted short tau inversion recovery (T2-STIR) cardiac magnetic resonance (CMR) over time, compared with that seen with perfusion single-photon emission computed tomography (SPECT) in patients with ST-segment elevation myocardial infarction, and to assess the amount of salvaged myocardium after 1 week. BACKGROUND: To assess reperfusion therapy, it is necessary to determine how much myocardium is salvaged by measuring the final infarct size in relation to the initial myocardium at risk of the left ventricle (LV). METHODS: Sixteen patients with first-time ST-segment elevation myocardial infarction received (99m)Tc tetrofosmin before primary percutaneous coronary intervention.... (More)
OBJECTIVES: Our goal was to validate myocardium at risk on T2-weighted short tau inversion recovery (T2-STIR) cardiac magnetic resonance (CMR) over time, compared with that seen with perfusion single-photon emission computed tomography (SPECT) in patients with ST-segment elevation myocardial infarction, and to assess the amount of salvaged myocardium after 1 week. BACKGROUND: To assess reperfusion therapy, it is necessary to determine how much myocardium is salvaged by measuring the final infarct size in relation to the initial myocardium at risk of the left ventricle (LV). METHODS: Sixteen patients with first-time ST-segment elevation myocardial infarction received (99m)Tc tetrofosmin before primary percutaneous coronary intervention. SPECT was performed within 4 h and T2-STIR CMR within 1 day, 1 week, 6 weeks, and 6 months. At 1 week, patients were injected with a gadolinium-based contrast agent for quantification of infarct size. RESULTS: Myocardium at risk at occlusion on SPECT was 33 +/- 10% of the LV. Myocardium at risk on T2-STIR did not differ from SPECT, at day 1 (29 +/- 7%, p = 0.49) or week 1 (31 +/- 6%, p = 0.16) but declined at week 6 (10 +/- 12%, p = 0.0096 vs. 1 week) and month 6 (4 +/- 11%, p = 0.0013 vs. 1 week). There was a correlation between myocardium at risk demonstrated by T2-STIR at week 1 and myocardium at risk by SPECT (r(2) = 0.70, p < 0.001), and the difference between the methods on Bland-Altman analysis was not significant (-2.3 +/- 5.7%, p = 0.16). Both modalities identified myocardium at risk in the same perfusion territory and in concordance with angiography. Final infarct size was 8 +/- 7%, and salvage was 75 +/- 19% of myocardium at risk. CONCLUSIONS: This study demonstrates that T2-STIR performed up to 1 week after reperfusion can accurately determine myocardium at risk as it was before opening of the occluded artery. CMR can also quantify salvaged myocardium as myocardium at risk minus final infarct size. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
JACC: Cardiovascular Imaging
volume
2
issue
5
pages
569 - 576
publisher
Elsevier
external identifiers
  • wos:000287653200007
  • pmid:19442942
  • scopus:65549119248
ISSN
1876-7591
DOI
10.1016/j.jcmg.2008.11.018
language
English
LU publication?
yes
id
1c3d9c34-b997-4587-865e-7adfbae1dae6 (old id 1412271)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/19442942?dopt=Abstract
date added to LUP
2009-06-03 12:59:37
date last changed
2017-12-10 03:48:53
@article{1c3d9c34-b997-4587-865e-7adfbae1dae6,
  abstract     = {OBJECTIVES: Our goal was to validate myocardium at risk on T2-weighted short tau inversion recovery (T2-STIR) cardiac magnetic resonance (CMR) over time, compared with that seen with perfusion single-photon emission computed tomography (SPECT) in patients with ST-segment elevation myocardial infarction, and to assess the amount of salvaged myocardium after 1 week. BACKGROUND: To assess reperfusion therapy, it is necessary to determine how much myocardium is salvaged by measuring the final infarct size in relation to the initial myocardium at risk of the left ventricle (LV). METHODS: Sixteen patients with first-time ST-segment elevation myocardial infarction received (99m)Tc tetrofosmin before primary percutaneous coronary intervention. SPECT was performed within 4 h and T2-STIR CMR within 1 day, 1 week, 6 weeks, and 6 months. At 1 week, patients were injected with a gadolinium-based contrast agent for quantification of infarct size. RESULTS: Myocardium at risk at occlusion on SPECT was 33 +/- 10% of the LV. Myocardium at risk on T2-STIR did not differ from SPECT, at day 1 (29 +/- 7%, p = 0.49) or week 1 (31 +/- 6%, p = 0.16) but declined at week 6 (10 +/- 12%, p = 0.0096 vs. 1 week) and month 6 (4 +/- 11%, p = 0.0013 vs. 1 week). There was a correlation between myocardium at risk demonstrated by T2-STIR at week 1 and myocardium at risk by SPECT (r(2) = 0.70, p &lt; 0.001), and the difference between the methods on Bland-Altman analysis was not significant (-2.3 +/- 5.7%, p = 0.16). Both modalities identified myocardium at risk in the same perfusion territory and in concordance with angiography. Final infarct size was 8 +/- 7%, and salvage was 75 +/- 19% of myocardium at risk. CONCLUSIONS: This study demonstrates that T2-STIR performed up to 1 week after reperfusion can accurately determine myocardium at risk as it was before opening of the occluded artery. CMR can also quantify salvaged myocardium as myocardium at risk minus final infarct size.},
  author       = {Carlsson, Marcus and Ubachs, Joey and Hedström, Erik and Heiberg, Einar and Jovinge, Stefan and Arheden, Håkan},
  issn         = {1876-7591},
  language     = {eng},
  number       = {5},
  pages        = {569--576},
  publisher    = {Elsevier},
  series       = {JACC: Cardiovascular Imaging},
  title        = {Myocardium at risk after acute infarction in humans on cardiac magnetic resonance: quantitative assessment during follow-up and validation with single-photon emission computed tomography.},
  url          = {http://dx.doi.org/10.1016/j.jcmg.2008.11.018},
  volume       = {2},
  year         = {2009},
}