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Cardiovascular magnetic resonance of the myocardium at risk in acute reperfused myocardial infarction: comparison of T2-weighted imaging versus the circumferential endocardial extent of late gadolinium enhancement with transmural projection

Ubachs, Joey LU ; Engblom, Henrik LU ; Erlinge, David LU ; Jovinge, Stefan LU ; Hedström, Erik LU ; Carlsson, Marcus LU and Arheden, Håkan LU (2010) In Journal of Cardiovascular Magnetic Resonance 12.
Abstract
Background: In the situation of acute coronary occlusion, the myocardium supplied by the occluded vessel is subject to ischemia and is referred to as the myocardium at risk (MaR). Single photon emission computed tomography has previously been used for quantitative assessment of the MaR. It is, however, associated with considerable logistic challenges for employment in clinical routine. Recently, T2-weighted cardiovascular magnetic resonance (CMR) has been introduced as a new method for assessing MaR several days after the acute event. Furthermore, it has been suggested that the endocardial extent of infarction as assessed by late gadolinium enhanced (LGE) CMR can also be used to quantify the MaR. Hence, we sought to assess the ability of... (More)
Background: In the situation of acute coronary occlusion, the myocardium supplied by the occluded vessel is subject to ischemia and is referred to as the myocardium at risk (MaR). Single photon emission computed tomography has previously been used for quantitative assessment of the MaR. It is, however, associated with considerable logistic challenges for employment in clinical routine. Recently, T2-weighted cardiovascular magnetic resonance (CMR) has been introduced as a new method for assessing MaR several days after the acute event. Furthermore, it has been suggested that the endocardial extent of infarction as assessed by late gadolinium enhanced (LGE) CMR can also be used to quantify the MaR. Hence, we sought to assess the ability of endocardial extent of infarction by LGE CMR to predict MaR as compared to T2-weighted imaging. Methods: Thirty-seven patients with early reperfused first-time ST-segment elevation myocardial infarction underwent CMR imaging within the first week after percutaneous coronary intervention. The ability of endocardial extent of infarction by LGE CMR to assess MaR was evaluated using T2-weighted imaging as the reference method. Results: MaR determined with T2-weighted imaging (34 +/- 10%) was significantly higher (p < 0.001) compared to the MaR determined with endocardial extent of infarction (23 +/- 12%). There was a weak correlation between the two methods (r(2) = 0.17, p = 0.002) with a bias of -11 +/- 12%. Myocardial salvage determined with T2-weighted imaging (58 +/- 22%) was significantly higher (p < 0.001) compared to myocardial salvage determined with endocardial extent of infarction (45 +/- 23%). No MaR could be determined by endocardial extent of infarction in two patients with aborted myocardial infarction. Conclusions: This study demonstrated that the endocardial extent of infarction as assessed by LGE CMR underestimates MaR in comparison to T2-weighted imaging, especially in patients with early reperfusion and aborted myocardial infarction. (Less)
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Contribution to journal
publication status
published
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in
Journal of Cardiovascular Magnetic Resonance
volume
12
publisher
BioMed Central
external identifiers
  • wos:000276646800001
  • scopus:77954571219
ISSN
1097-6647
DOI
10.1186/1532-429X-12-18
language
English
LU publication?
yes
id
7ddc090d-c0dd-4c60-b143-5539d687870d (old id 1603015)
date added to LUP
2010-05-19 10:19:00
date last changed
2018-05-29 09:34:07
@article{7ddc090d-c0dd-4c60-b143-5539d687870d,
  abstract     = {Background: In the situation of acute coronary occlusion, the myocardium supplied by the occluded vessel is subject to ischemia and is referred to as the myocardium at risk (MaR). Single photon emission computed tomography has previously been used for quantitative assessment of the MaR. It is, however, associated with considerable logistic challenges for employment in clinical routine. Recently, T2-weighted cardiovascular magnetic resonance (CMR) has been introduced as a new method for assessing MaR several days after the acute event. Furthermore, it has been suggested that the endocardial extent of infarction as assessed by late gadolinium enhanced (LGE) CMR can also be used to quantify the MaR. Hence, we sought to assess the ability of endocardial extent of infarction by LGE CMR to predict MaR as compared to T2-weighted imaging. Methods: Thirty-seven patients with early reperfused first-time ST-segment elevation myocardial infarction underwent CMR imaging within the first week after percutaneous coronary intervention. The ability of endocardial extent of infarction by LGE CMR to assess MaR was evaluated using T2-weighted imaging as the reference method. Results: MaR determined with T2-weighted imaging (34 +/- 10%) was significantly higher (p &lt; 0.001) compared to the MaR determined with endocardial extent of infarction (23 +/- 12%). There was a weak correlation between the two methods (r(2) = 0.17, p = 0.002) with a bias of -11 +/- 12%. Myocardial salvage determined with T2-weighted imaging (58 +/- 22%) was significantly higher (p &lt; 0.001) compared to myocardial salvage determined with endocardial extent of infarction (45 +/- 23%). No MaR could be determined by endocardial extent of infarction in two patients with aborted myocardial infarction. Conclusions: This study demonstrated that the endocardial extent of infarction as assessed by LGE CMR underestimates MaR in comparison to T2-weighted imaging, especially in patients with early reperfusion and aborted myocardial infarction.},
  author       = {Ubachs, Joey and Engblom, Henrik and Erlinge, David and Jovinge, Stefan and Hedström, Erik and Carlsson, Marcus and Arheden, Håkan},
  issn         = {1097-6647},
  language     = {eng},
  publisher    = {BioMed Central},
  series       = {Journal of Cardiovascular Magnetic Resonance},
  title        = {Cardiovascular magnetic resonance of the myocardium at risk in acute reperfused myocardial infarction: comparison of T2-weighted imaging versus the circumferential endocardial extent of late gadolinium enhancement with transmural projection},
  url          = {http://dx.doi.org/10.1186/1532-429X-12-18},
  volume       = {12},
  year         = {2010},
}