Cardiac MRI to Visualize Myocardial Damage after ST-Segment Elevation Myocardial Infarction: A Review of Its Histologic Validation

Beijnink, Casper W.H.; Hoeven, Nina W. van der; Konijnenberg, Lara S F; Kim, Raymond J.; Bekkers, Sebastiaan C.A.M.; Kloner, Robert A.; Everaars, Henk; Messaoudi, Saloua El; Rossum, Albert C. van; Royen, Niels van; Nijveldt, Robin

doi:10.1148/radiol.2021204265

Cited by 47 publications

(31 citation statements)

References 101 publications

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“…Yet, this logistically demanding approach is not broadly feasible and has not been available in our setting. In CMR, AAR has been proposed to be estimated via quantity of edema in T2-weighted images, but preclinical histologic validation delivered partly inconclusive results on colocalization of edema and AAR (30). In our study, FAP signal partly colocalized with detected edema in T2 weighted images.…”

Section: Discussionmentioning

confidence: 51%

Cardiac Fibroblast Activation in Patients Early After Acute Myocardial Infarction: Integration with MR Tissue Characterization and Subsequent Functional Outcome

et al. 2022

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Background and RationaleAfter acute myocardial infarction (AMI), fibroblast activation protein (FAP) upregulation exceeds the infarct region. We sought further insights into the physiologic relevance by correlating FAP-targeted PET with tissue characteristics from cardiac magnetic resonance (CMR) and functional outcome. MethodsThirty-five patients underwent CMR, perfusion SPECT, and 68 Ga-FAPI-46 PET/CT within 11 days after AMI. Infarct size was determined from SPECT by comparison to reference database.For PET, regional standardized uptake values (SUV) and isocontour volumes-of-interest (VOI) determined the extent of cardiac FAP upregulation (FAP-volume). CMR yielded functional parameters, area of injury (late gadolinium enhancement, LGE) and T1/T2 mapping. Follow-up was available from echocardiography or CMR after 139.5 (IQR 80.5-188.25) days (n=14). ResultsThe area of FAP-upregulation was significantly larger than SPECT perfusion defect size (58±15 vs. 23±17%, p<0.001) and infarct area by LGE (28±11%, p<0.001). FAP-volume significantly correlated with CMR parameters at baseline (all p<0.001): infarct area (r=0.58), left ventricular (LV) mass (r=0.69), endsystolic (r=0.62) and enddiastolic volume (r=0.57). Segmental analysis revealed FAP-upregulation in 308/496 myocardial segments (62%). Significant LGE was found in only 56% of FAP-positive segments, elevated T1 in 74%, and elevated T2 in 68%. 14% (44/308) of FAP-positive segments exhibited neither prolonged T1 or T2 nor significant LGE. Of note, FAP-volume correlated only weakly with simultaneously measured left ventricular ejection fraction (LVEF) at baseline (r=-0.32, p=0.07), whereas there was a significant inverse correlation with LVEF obtained at later follow-up (r=-0.58, p=0.007).

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Section: Discussionmentioning

confidence: 51%

Cardiac Fibroblast Activation in Patients Early After Acute Myocardial Infarction: Integration with MR Tissue Characterization and Subsequent Functional Outcome

et al. 2022

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“…The process of reperfusion therapy is a double-edged sword that accounts for salvaged myocardium; paradoxically, it is also a driving factor that contributes to additional myocardial damage ( 30 ). In patients with STEMI, myocardial AAR is the proportion of myocardium that is at risk of becoming necrotic, supplied by occluded artery, and it exceeds irreversibly infarct myocardium ( 13 ). The amount of salvaged myocardium is derived by subtracting IS from the edematous area ( 4 ).…”

Section: Discussionmentioning

confidence: 99%

“…However, histologic findings in animal models cannot directly represent the conditions in the human body. Moreover, microvascular damage, ranging from microvascular obstruction to intramyocardial hemorrhage, always overlaps with edema, thus mitigating T1 prolongations, and leading to underestimation of the resultant T1 value ( 13 ). Further clinical trials and multiple parallel compare methods are needed to verify the potential of native T1 mapping in quantifying irreversible infarct areas.…”

Section: Discussionmentioning

confidence: 99%

“…Besides that, a comprehensive CMR can be challenging and time-consuming for patients with AMI, obviating some scanning protocols and shortening scanning duration without compromising data acquisition would be an ideal approach ( 12 ). Native T1 mapping can identify myocardial fibrosis and quantify IS without utilizing gadolinium agents ( 13 – 15 ), which gives an estimate of IS for particular patient groups. A high T2 signal reflects an increased myocardial water content; T2 mapping is confirmed effective in assessing myocardial edema, which is considered as AAR in AMI ( 16 ).…”

Section: Introductionmentioning

confidence: 99%

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Prognostic significance of myocardial salvage assessed by cardiac magnetic resonance in reperfused ST-segment elevation myocardial infarction

Wang

et al. 2022

Front. Cardiovasc. Med.

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AimsMyocardial salvage index (MSI) is attracting increasing attention for predicting prognosis in acute myocardial infarction (AMI); however, the evaluation of MSI is mainly based on contrast agent-dependent cardiac magnetic resonance (CMR) scanning sequences. This study aims to investigate the prognostic value of MSI in reperfused ST-segment elevation myocardial infarction (STEMI) through the contrast agent-free CMR technique.Methods and resultsNighty-two patients with acute STEMI, who underwent CMR after primary percutaneous coronary intervention (PPCI), were finally enrolled. Patients were subcategorized into two groups according to median MSI. T1 and T2 mapping were conducted for measuring infarct size (IS) and area at risk (AAR). IS was significantly larger in < median MSI group than ≥ median MSI group (P < 0.001). AAR between the two groups showed no obvious differences (P = 0.108). Left ventricular ejection fraction (LVEF) was lower in < median MSI group than ≥ median MSI group (P = 0.014). There was an obvious inverse correlation between MSI and reperfusion time (R = –0.440, P < 0.001) and a strong inverse correlation between MSI and IS (R = –0.716, P = 0.011). As for the relationship LVEF, MSI showed positive but weak correlation (R = 0.2265, P < 0.001). Over a median follow-up period of 263 (227–238) days, prevalence of MACEs was significantly higher in the < median MSI group [HR: 0.15 (0.04–0.62); Log-rank P = 0.008]. The univariate Cox regression analysis revealed that LVEF, IS, and MSI were significant predictors for major adverse cardiovascular events (MACEs) (all P < 0.05). In the stepwise multivariate Cox regression analysis, LVEF and MSI were identified as independent parameters for predicting MACEs (both P < 0.05). In the receiver-operating characteristic analysis, LVEF, IS, and MSI showed prognostic value in predicting MACEs with AUCs of 0.809, 0.779, and 0.896, respectively, all (P < 0.05). A combination of MSI with LVEF showed the strongest prognostic value of MACEs (AUC: 0.901, sensitivity: 77.78%, specificity: 98.80%, P < 0.001). Delong’s test showed that the combination of LVEF with MSI had an incremental value than LVEF itself in predicting MACEs (P = 0.026).ConclusionContrast agent-free CMR technique provides a reliable evaluation of MSI, which contributes to assessing the efficacy of reperfusion therapy and predicting the occurrence of MACEs.

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“…Thus, the question remains as to which standard biomarker concentrations can be weighed, and a possible answer points in the direction of cardiac imaging. Although several modalities exist, especially cardiac magnetic resonance combined with late gadolinium enhancement accurately predicts infarct size and long‐term outcome 16,17 . A first attempt in the postoperative phase following CABG was made by Pegg et al 18 in a relatively small subgroup analysis, demonstrating the superiority of cTn for detection of periprocedural myocardial necrosis.…”

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confidence: 99%

Towards an improved definition of periprocedural myocardial infarction: The role of high‐sensitivity cardiac troponins

Heuts¹,

Horst²,

Mingels

2021

Journal of Cardiac Surgery

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In the past few years, many have disputed the optimal biomarker for confirming or ruling out a diagnosis of periprocedural myocardial infarction (PMI) and the optimal cut‐off concentrations to apply. In this issue of the Journal of Cardiac Surgery, Niclauss et al. performed a retrospective analysis of CK‐MB and high‐sensitivity cardiac troponin T (hs‐cTnT) dynamics and peak concentrations following different cardiac surgical interventions in 400 patients during a 2‐year period in a single center. The authors found that CK‐MB and hs‐cTnT predict PMI with a comparable diagnostic accuracy and discriminatory power >95%. They also attempted to propose an improved, more sensitive threshold of hs‐cTnT for PMI. Their findings could have implications for clinical practice, but more research is warranted to identify more appropriate cut‐offs. This could include hs‐cTnT release pattern, slope steepness, and changes. Ultimately, this could results in patient‐specific model, able to predict expected and abnormal ranges of hs‐cTnT release, enabling an improved and timely diagnosis of PMI.

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Cardiac MRI to Visualize Myocardial Damage after ST-Segment Elevation Myocardial Infarction: A Review of Its Histologic Validation

Cited by 47 publications

References 101 publications

Cardiac Fibroblast Activation in Patients Early After Acute Myocardial Infarction: Integration with MR Tissue Characterization and Subsequent Functional Outcome

Cardiac Fibroblast Activation in Patients Early After Acute Myocardial Infarction: Integration with MR Tissue Characterization and Subsequent Functional Outcome

Prognostic significance of myocardial salvage assessed by cardiac magnetic resonance in reperfused ST-segment elevation myocardial infarction

Towards an improved definition of periprocedural myocardial infarction: The role of high‐sensitivity cardiac troponins

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