Accurate and objective infarct sizing by contrast-enhanced magnetic resonance imaging in a canine myocardial infarction model

Amado, Luciano C.; Gerber, Bernhard; Gupta, Sandeep; Rettmann, Dan; Szarf, Gilberto; Schock, Robert B; Nasir, Khurram; Kraitchman, Dara L.; Lima, João A.C.

doi:10.1016/j.jacc.2004.09.020

Cited by 455 publications

(405 citation statements)

References 22 publications

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“…The extent of LGE as a percentage of LV mass was calculated automatically by the software. The full width at half maximum method17 was used for defining the threshold for LGE: Tissue with a signal intensity >50% of the maximum signal of the enhanced myocardium was quantified as scar tissue. In T2‐weighted images, regions of interest were drawn on remote skeletal muscle and on the LV segments in which myocardial edema was suspected.…”

Section: Methodsmentioning

confidence: 99%

Magnetic Resonance Imaging as a Predictor of Survival Free of Life‐Threatening Arrhythmias and Transplantation in Cardiac Sarcoidosis

Ekström

Lehtonen

Hänninen

et al. 2016

JAHA

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BackgroundCardiac magnetic resonance imaging has a key role in today's diagnosis of cardiac sarcoidosis. We set out to investigate whether cardiac magnetic resonance imaging also helps predict outcome in cardiac sarcoidosis.Methods and ResultsOur work involved 59 patients with cardiac sarcoidosis (38 female, mean age 46±10 years) seen at our hospital since February 2004 and followed up after contrast‐enhanced cardiac magnetic resonance imaging. The extent of myocardial late gadolinium enhancement (measured as percentage of left ventricular mass), the volumes and ejection fractions of the left and right ventricles, and the thickness of the basal interventricular septum were determined and analyzed for prognostic significance. By April 2015, 23 patients had reached the study's end point, consisting of a composite of cardiac death (n=3), cardiac transplantation (n=1), and occurrence of life‐threatening ventricular tachyarrhythmias (n=19; ventricular fibrillation in 5 and sustained ventricular tachycardia in 14 patients). In univariate analysis, myocardial extent of late gadolinium enhancement predicted event‐free survival, as did scar‐like thinning (<4 mm) of the basal interventricular septum and the ejection fraction of the right ventricle (P<0.05 for all). In multivariate Cox regression analysis, extent of late gadolinium enhancement was the only independent predictor of outcome events on cardiac magnetic resonance imaging, with a hazard ratio of 2.22 per tertile (95% CI 1.07–4.59). An extent of late gadolinium enhancement >22% (third tertile) had positive and negative predictive values for serious cardiac events of 75% and 76%, respectively.ConclusionsFindings on cardiac magnetic resonance imaging and the extent of myocardial late gadolinium enhancement in particular help predict serious cardiac events in cardiac sarcoidosis.

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Section: Methodsmentioning

confidence: 99%

Magnetic Resonance Imaging as a Predictor of Survival Free of Life‐Threatening Arrhythmias and Transplantation in Cardiac Sarcoidosis

Ekström

Lehtonen

Hänninen

et al. 2016

JAHA

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“…The gray scale LGE MRI images (2D slices), with voxel size of 1 mm 3 , were analyzed and five different tissue types were defined based on the pattern of enhancement 14. The enhancement was categorized by the number of standard deviations (SD) above the mean intensity of a remote area of normal tissue on each slice (baseline intensity).…”

Section: Methodsmentioning

confidence: 99%

Correlation of Scar in Cardiac MRI and High‐Resolution Contact Mapping of Left Ventricle in a Chronic Infarct Model

Thajudeen

Jackman

Stewart

et al. 2015

Pacing Clinical Electrophis

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BackgroundEndocardial mapping for scars and abnormal electrograms forms the most essential component of ventricular tachycardia ablation. The utility of ultra‐high resolution mapping of ventricular scar was assessed using a multielectrode contact mapping system in a chronic canine infarct model.MethodsChronic infarcts were created in five anesthetized dogs by ligating the left anterior descending coronary artery. Late gadolinium‐enhanced magnetic resonance imaging (LGE MRI) was obtained 4.9 ± 0.9 months after infarction, with three‐dimensional (3D) gadolinium enhancement signal intensity maps at 1‐mm and 5‐mm depths from the endocardium. Ultra‐high resolution electroanatomical maps were created using a novel mapping system (Rhythmia Mapping System, Rhythmia Medical/Boston Scientific, Marlborough, MA, USA) Rhythmia Medical, Boston Scientific, Marlborough, MA, USA with an 8.5F catheter with mini‐basket electrode array (64 tiny electrodes, 2.5‐mm spacing, center‐to‐center).ResultsThe maps contained 7,754 ± 1,960 electrograms per animal with a mean resolution of 2.8 ± 0.6 mm. Low bipolar voltage (<2 mV) correlated closely with scar on the LGE MRI and the 3D signal intensity map (1‐mm depth). The scar areas between the MRI signal intensity map and electroanatomic map matched at 87.7% of sites. Bipolar and unipolar voltages, compared in 592 electrograms from four MRI‐defined scar types (endocardial scar, epicardial scar, mottled transmural scar, and dense transmural scar) as well as normal tissue, were significantly different. A unipolar voltage of <13 mV correlated with transmural extension of scar in MRI. Electrograms exhibiting isolated late potentials (ILPs) were manually annotated and ILP maps were created showing ILP location and timing. ILPs were identified in 203 ± 159 electrograms per dog (within low‐voltage areas) and ILP maps showed gradation in timing of ILPs at different locations in the scar.ConclusionsUltra‐high resolution contact electroanatomical mapping accurately localizes ventricular scar and abnormal myocardial tissue in this chronic canine infarct model. The high fidelity electrograms provided clear identification of the very low amplitude ILPs within the scar tissue and has the potential to quickly identify targets for ablation.

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“…This is because it has been conclusively shown that delayed hyper-enhancement seen on MRI (DE-MRI) is exclusively associated with myocyte necrosis. 8,9 The utility of CMRI in apical ballooning was recently investigated by Mitchell et al 10 Though, there were concerns about resolution of CMRI to detect changes at microscopic level, excellent correlation has been shown between DE-MRI and histopathology even for small infarcts. 8,9,11,12 It is important to note that regions subjected to severe but reversible ischaemic injuries do not hyper-enhance on DE-MRI, even in the presence of myocardial stunning.…”

Section: Discussionmentioning

confidence: 99%

Magnetic resonance imaging findings in apical ballooning syndrome or takotsubo cardiomyopathy

Jambhekar

Pandey

Kaushik

et al. 2012

Indian Heart Journal

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A B S T R A C TCardiac magnetic resonance imaging (CMRI) plays an important role in the diagnosis and followup of apical ballooning syndrome (takotsubo syndrome), a recently described cardiac condition characterised by transient dyskinesia of the left ventricle secondary to an acute emotional event.We present the CMRI findings in a 53-year-old female diagnosed with apical ballooning syndrome and discuss its value in the diagnosis and follow-up of this condition.

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Accurate and objective infarct sizing by contrast-enhanced magnetic resonance imaging in a canine myocardial infarction model

Abstract: When an objective technique is used to define MI size by CE-MRI, accurate infarct size measurements can be obtained from images obtained up to 30 min after contrast administration.

Cited by 455 publications

References 22 publications

Magnetic Resonance Imaging as a Predictor of Survival Free of Life‐Threatening Arrhythmias and Transplantation in Cardiac Sarcoidosis

Magnetic Resonance Imaging as a Predictor of Survival Free of Life‐Threatening Arrhythmias and Transplantation in Cardiac Sarcoidosis

Correlation of Scar in Cardiac MRI and High‐Resolution Contact Mapping of Left Ventricle in a Chronic Infarct Model

Magnetic resonance imaging findings in apical ballooning syndrome or takotsubo cardiomyopathy

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