Contrast-Enhanced CMR Overestimates Early Myocardial Infarct Size

Jablonowski, Robert; Engblom, Henrik; Kanski, Mikael; Nordlund, David; Koul, Sasha; Pals, Jesper van der; Englund, Elisabet; Heiberg, Einar; Erlinge, David; Carlsson, Marcus; Arheden, Håkan

doi:10.1016/j.jcmg.2015.08.015

Cited by 56 publications

(42 citation statements)

References 22 publications

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“…Most CMR parameters of myocardial function and infarct severity change significantly over time [143][144][145][146]. Therefore, performing CMR very early after PCI (Day 1) leads to a considerable overestimation of IS because of edema and partial volume effect [147]. In contrast, IS by LGE and MVO are relative stable between Days 3 and 7 after STEMI and have strongest evidence for risk prediction in this time period [17,48,143].…”

Section: Remaining Challenges and Opportunitiesmentioning

confidence: 99%

Role of Cardiac Magnetic Resonance to Improve Risk Prediction following Acute ST-elevation Myocardial Infarction

Reindl

Eitel

Reinstadler

2020

JCM

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Cardiac magnetic resonance (CMR) imaging allows comprehensive assessment of myocardial function and tissue characterization in a single examination after acute ST-elevation myocardial infarction. Markers of myocardial infarct severity determined by CMR imaging, especially infarct size and microvascular obstruction, strongly predict recurrent cardiovascular events and mortality. The prognostic information provided by a comprehensive CMR analysis is incremental to conventional risk factors including left ventricular ejection fraction. As such, CMR parameters of myocardial tissue damage are increasingly recognized for optimized risk stratification to further ameliorate the burden of recurrent cardiovascular events in this population. In this review, we provide an overview of the current impact of CMR imaging on optimized risk assessment soon after acute ST-elevation myocardial infarction.

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Section: Remaining Challenges and Opportunitiesmentioning

confidence: 99%

Role of Cardiac Magnetic Resonance to Improve Risk Prediction following Acute ST-elevation Myocardial Infarction

Reindl

Eitel

Reinstadler

2020

JCM

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“…82 In a recent study by Carrick and colleagues 12 , MI size was shown to be similar between days 1 and 3, and reduced in size by day 10. Jablonowski and colleagues 83 recently provided some mechanistic insights into this phenomenon in a porcine model of acute MI. At day 1, they found higher ECV values in the peri-infarct zone that could be due to severe edema or a mixture of infarcted and salvaged myocardium in that area that contributed to the overestimation of MI size.…”

Section: Current Controversies In Cmr Imaging Of Stemi Patientsmentioning

confidence: 99%

Cardiovascular Magnetic Resonance in Acute ST-Segment–Elevation Myocardial Infarction

et al. 2018

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While mortality following ST-segment elevation myocardial infarction (STEMI) is on the decline, the number of patients developing heart failure due to prior myocardial infarction (MI) is on the rise. Apart from timely reperfusion by primary percutaneous coronary intervention (PPCI), there is currently no established therapy for reducing MI size. As such new cardioprotective therapies are required to improve clinical outcomes following STEMI. Cardiovascular magnetic resonance (CMR) has emerged as an important imaging modality for assessing the efficacy of novel therapies for reducing MI size and preventing subsequent adverse left ventricular remodeling. The recent availability of multi-parametric mapping CMR has provided new insights into the pathophysiology underlying myocardial edema, microvascular obstruction, intramyocardial hemorrhage, and changes in the remote myocardial interstitial space following STEMI. In this article, we provide an overview of the recent advances in CMR imaging in reperfused STEMI patients, discuss the controversies surrounding its use, and explore future applications of CMR in this setting.

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“…The use of PSIR sequences mitigates the difficulties associated with choosing correct TI times, reducing the bias that may be due to imaging parameters and addressing technical variables that may have contributed to the disparate findings. Overestimation of infarct size by gadolinium enhancement was recently confirmed in a porcine study by Jablonowski et al using a PSIR sequence (12). …”

Section: Discussionmentioning

confidence: 80%

“…Recently published data also showed that the salvaged myocardium in a porcine model of ischemia and reperfusion had an increased ECV compared to normal myocardium both one day and seven days after ischemia (12). This provides a basis for the understanding of accumulation of gadolinium, an extracellular contrast agent, not only in the irreversibly damaged myocardium, but also in reversibly damaged myocardium.…”

Section: Discussionmentioning

confidence: 99%

Early Gadolinium Enhancement for Determination of Area at Risk

Hammer-Hansen

Leung

Hsu

et al. 2017

JACC: Cardiovascular Imaging

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Objectives The aim of this study was to determine if early gadolinium enhancement (EGE) by cardiovascular magnetic resonance (CMR) imaging in a canine model of reperfused myocardial infarction depicts the area at risk (AAR) as determined by microsphere blood flow analysis. Background It remains controversial whether only the irreversibly injured myocardium enhances when performing CMR imaging in the setting of acute myocardial infarction. Recently, EGE has been proposed as a measure of the AAR in acute myocardial infarction as it correlates well with T2-weighted imaging of the AAR, but still requires pathological validation. Methods Eleven dogs underwent 2 hours of coronary artery occlusion and 48 hours of reperfusion prior to imaging at 1.5T. EGE imaging was performed 3 minutes after contrast administration with coverage of the entire left ventricle. Late gadolinium enhancement (LGE) imaging was performed between 10 and 15 minutes after contrast injection. AAR was defined as myocardium with blood flow (mL/min/g) <2SD from remote myocardium determined by microspheres during occlusion. The size of infarction was determined using triphenyltetrazolium chloride (TTC). Results There was no significant difference in the size of enhancement by EGE compared to the size of AAR by microspheres (44.1± 15.8% vs. 42.7± 9.2%, p=0.61) with good correlation (r=0.88, p <0.001) and good agreement by Bland-Altman analysis (mean bias 1.4± 17.4%). There was no difference in the size of enhancement by EGE compared to enhancement on native T1 and T2 maps. The size of EGE was significantly greater than the infarct by TTC, (44.1± 15.8% vs. 20.7± 14.4%, p<0.001) and LGE (44.1± 15.8% vs. 23.5± 12.7%, p<0.001). Conclusion At three minutes post-contrast, EGE correlated well with the AAR by microspheres and CMR, and was greater than infarct size. Thus, EGE enhances both reversibly and irreversibly injured myocardium.

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Contrast-Enhanced CMR Overestimates Early Myocardial Infarct Size

Cited by 56 publications

References 22 publications

Role of Cardiac Magnetic Resonance to Improve Risk Prediction following Acute ST-elevation Myocardial Infarction

Role of Cardiac Magnetic Resonance to Improve Risk Prediction following Acute ST-elevation Myocardial Infarction

Cardiovascular Magnetic Resonance in Acute ST-Segment–Elevation Myocardial Infarction

Early Gadolinium Enhancement for Determination of Area at Risk

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