Acute Myocardial Infarction: Serial Cardiac MR Imaging Shows a Decrease in Delayed Enhancement of the Myocardium during the 1st Week after Reperfusion

Ibrahim, Tareq; Hackl, Thomas; Nekolla, Stephan G.; Breuer, Martin; Feldmair, Michael; Schömig, Albert; Schwaiger, Markus

doi:10.1148/radiol.09090660

Cited by 104 publications

(74 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Use of thinner slices, fat-saturation prepulses, and optimized inversion times may help to improve RV LGE detection. Although some reports suggest that infarct-related edema within the viable portion of the jeopardized LV myocardium can contribute to early postinfarction LGE, 26,27 further research is warranted to assess whether peri-infarct edema plays a role in the reduction of frequency and extent of RV LGE at follow-up.…”

Section: Discussionmentioning

confidence: 99%

Right Ventricular Ischemic Injury in Patients With Acute ST-Segment Elevation Myocardial Infarction

et al. 2010

View full text Add to dashboard Cite

Background-Experimental data show that the right ventricle (RV) is more resistant to ischemia than the left ventricle. To date, limited data are available in humans because of the difficulty of discriminating reversible from irreversible ischemic damage. We sought to characterize RV ischemic injury in patients with reperfused myocardial infarction using cardiovascular magnetic resonance. Methods and Results-In 3 tertiary centers, 242 consecutive patients with reperfused acute ST-segment elevation myocardial infarction were studied with cardiovascular magnetic resonance at 1 week and 4 months after myocardial infarction. T2-weighted and postcontrast cardiovascular magnetic resonance scans were used to depict myocardial edema and late gadolinium enhancement, respectively. Early after infarction, RV edema was common (51% of patients), often associated with late gadolinium enhancement (31% of patients). Remarkably, RV edema and late gadolinium enhancement were found in 33% and 12% of anterior left ventricular infarcts, respectively. Baseline regional and global RV functions were inversely related to the presence and extent of RV edema and RV late gadolinium enhancement. At follow-up, a significant decrease in frequency (25/242 patients; 10%) and extent of RV late gadolinium enhancement was observed (PϽ0.001). With the use of multivariable analysis, the presence of RV edema was an independent predictor of RV global function improvement during follow-up (␤-coefficientϭ0.221, Pϭ0.003). Conclusions-Early postinfarction RV ischemic injury is common and is characterized by the presence of myocardial edema, late gadolinium enhancement, and functional abnormalities. RV injury is not limited to inferior infarcts but is commonly found in anterior infarcts as well. Cardiovascular magnetic resonance findings suggest reversibility of acute RV dysfunction with limited permanent myocardial damage at 4-month follow-up. (Circulation.

show abstract

Section: Discussionmentioning

confidence: 99%

Right Ventricular Ischemic Injury in Patients With Acute ST-Segment Elevation Myocardial Infarction

et al. 2010

View full text Add to dashboard Cite

show abstract

“…[13][14][15] The accuracy of segmental LGE expressed as segmental area of late gadolinium-enhancement (SEE) defined as enhanced percentage of segmental area, [10][11][12]16 rather than maximum transmurality in predicting segmental recovery in acute STEMI has shown promise.…”

Section: Khan Et Al Cmr Predictors Of Segmental Recovery In Stemimentioning

confidence: 99%

“…[5][6][7][8][9][10][11][12] Moreover, several reports have shown that LGE, measured within days of STEMI, overestimates acute infarct size (IS) and underestimates the potential for functional recovery. [13][14][15] The accuracy of segmental LGE expressed as segmental area of late gadolinium-enhancement (SEE) defined as enhanced percentage of segmental area, [10][11][12]16 rather than maximum transmurality in predicting segmental recovery in acute STEMI has shown promise.…”

Section: Khan Et Al Cmr Predictors Of Segmental Recovery In Stemimentioning

confidence: 99%

“…4,5,[7][8][9][10][11][12] The accuracy in predicting recovery was slightly lower than in the work of Kitagawa et al 8 and Orii et al 12 LGE measured acutely overestimates necrosis by up to 30% in the first week post STEMI caused by myocardial edema. 13,15 We undertook acute CMR at 3 days post PPCI to assess CMR in a real-world setting when patients are discharged and are less likely to undergo CMR at day 5 and 8 as in these 2 studies. 8,12 Untreated multivessel disease with potential hibernating myocardium in noninfarct artery territories in our study, differences in LGE thresholding methods, 4,5,[7][8][9][10]12 and the smaller sample size of these studies may also have contributed to our slightly lower AUC.…”

Section: Prediction Of Segmental Functional Recovery With Lgementioning

confidence: 99%

See 1 more Smart Citation

Relationship of Myocardial Strain and Markers of Myocardial Injury to Predict Segmental Recovery After Acute ST-Segment–Elevation Myocardial Infarction

Khan

Nazir

Singh

et al. 2016

Circ: Cardiovascular Imaging

View full text Add to dashboard Cite

I mprovement in dysfunctional myocardium after acute ST-segment-elevation myocardial infarction (STEMI) predicts long-term myocardial function and prognosis. Background-Late gadolinium-enhanced cardiovascular magnetic resonance imaging overestimates infarct size and underestimates recovery of dysfunctional segments acutely post ST-segment-elevation myocardial infarction. We assessed whether cardiovascular magnetic resonance imaging-derived segmental myocardial strain and markers of myocardial injury could improve the accuracy of late gadolinium-enhancement in predicting functional recovery after ST-segment-elevation myocardial infarction. Methods and Results-A total of 164 ST-segment-elevation myocardial infarction patients underwent acute (median 3 days) and follow-up (median 9.4 months) cardiovascular magnetic resonance imaging. Wall-motion scoring, feature tracking-derived circumferential strain (Ecc), segmental area of late gadolinium-enhancement (SEE), microvascular obstruction, intramyocardial hemorrhage, and salvage index (MSI) were assessed in 2624 segments. We used logistic regression analysis to identify markers that predict segmental recovery. At acute CMR 32% of segments were dysfunctional, and at follow-up CMR 19% were dysfunctional. Segmental function at acute imaging and odds ratio (OR) Khan et al CMR Predictors of Segmental Recovery in STEMIand stunned 4 myocardium, allowing the prediction of functional recovery without inotropic challenge.1,2 However, the evidence base in acute STEMI is limited by a small number of single-center studies and heterogeneity of LGE assessment.5-12 Moreover, several reports have shown that LGE, measured within days of STEMI, overestimates acute infarct size (IS) and underestimates the potential for functional recovery. [13][14][15] The accuracy of segmental LGE expressed as segmental area of late gadolinium-enhancement (SEE) defined as enhanced percentage of segmental area, [10][11][12]16 rather than maximum transmurality in predicting segmental recovery in acute STEMI has shown promise.Several other CMR markers of myocardial injury have been associated with functional recovery after STEMI. Circumferential strain (Ecc), 11 myocardial salvage (MSI), 17LGE-derived microvascular obstruction (late MVO), 11,17,18 and intramyocardial hemorrhage (IMH) 18 have been assessed in a few small studies. There are no studies investigating whether they offer additive value to the predictive accuracy of LGE. Feature tracking (FT) is a novel postprocessing software for the quantification of myocardial strain from steady state freeprecession cine images 19,20 We have recently demonstrated greater robustness, reproducibility, and infarct correlation with FT-derived strain compared with tagging in acute STEMI. 21 We aimed to assess whether FT-derived Ecc, MSI, late MVO, and IMH predicted segmental functional recovery in acute STEMI and whether this was of additive value to SEE. Methods Study PopulationTwo hundred and three STEMI patients with multivessel coronary disease were recrui...

show abstract

“…35 With the combination of the inversion recovery technique described by Simonetti et al, 36 it became possible to maximize the contrast between viable and 37,38 There is significant decrease in the total extent of LGE between day 1 and day 7 post-MI. [39][40][41] CMR can be used in assessing MI size up to 1 week after the acute ischemic event. With time, the size of the infarct decreases as a result of resolution of tissue edema and gradual contraction of the resultant scar tissue by as much as 25% over a period of 4-8 weeks.…”

Section: Late Gadolinium Enhancementmentioning

confidence: 99%

Correlation of Electrocardiogram and Regional Cardiac Magnetic Resonance Imaging Findings in ST‐Elevation Myocardial Infarction: A Literature Review

Rinta-Kiikka

Tuohinen

Ryymin

et al. 2014

Noninvasive Electrocardiol

View full text Add to dashboard Cite

Background:Patients with acute ST-elevation myocardial infarction (STEMI) benefit substantially from emergent coronary reperfusion. The principal mechanism is to open the occluded coronary artery to minimize myocardial injury. Thus the size of the area at risk is a critical determinant of the patient outcome, although other factors, such as reperfusion injury, have major impact on the final infarct size. Acute coronary occlusion almost immediately induces metabolic changes within the myocardium, which can be assessed with both the electrocardiogram (ECG) and cardiac magnetic resonance (CMR) imaging.Methods: The 12-lead ECG is the principal diagnostic method to detect and risk-stratify acute STEMI. However, to achieve a correct diagnosis, it is paramount to compare different ECG parameters with golden standards in imaging, such as CMR. In this review, we discuss aspects of ECG and CMR in the assessment of acute regional ischemic changes in the myocardium using the 17 segment model of the left ventricle presented by American Heart Association (AHA), and their relation to coronary artery anatomy.Results: Using the 17 segment model of AHA, the segments 12 and 16 remain controversial. There is an important overlap in myocardial blood supply at the antero-lateral region between LAD and LCx territories concerning these two segments.Conclusion: No all-encompassing correlation can be found between ECG and CMR findings in acute ischemia with respect to coronary anatomy.

show abstract

Acute Myocardial Infarction: Serial Cardiac MR Imaging Shows a Decrease in Delayed Enhancement of the Myocardium during the 1st Week after Reperfusion

Cited by 104 publications

References 36 publications

Right Ventricular Ischemic Injury in Patients With Acute ST-Segment Elevation Myocardial Infarction

Right Ventricular Ischemic Injury in Patients With Acute ST-Segment Elevation Myocardial Infarction

Relationship of Myocardial Strain and Markers of Myocardial Injury to Predict Segmental Recovery After Acute ST-Segment–Elevation Myocardial Infarction

Correlation of Electrocardiogram and Regional Cardiac Magnetic Resonance Imaging Findings in ST‐Elevation Myocardial Infarction: A Literature Review

Contact Info

Product

Resources

About