Microvascular perfusion 1 week and 6 months after myocardial infarction by first-pass perfusion cardiovascular magnetic resonance imaging

Bodı́, Vicente; Sanchís, Juan; López‐Lereu, María P.; Núñez, Julio; Sanz, Roberto; Palau, Patricia; Gómez, Cristina; Moratal, David; Chorro, Francisco J.; Llàcer, Àngel

doi:10.1136/hrt.2005.077305

Cited by 36 publications

(16 citation statements)

References 19 publications

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“…Quantification of myocardial blood flow (MBF) has been shown to be an effective tool for diagnosing blood flow defects (regional or global myocardium) and monitoring the effectiveness of therapeutic treatment (1)(2)(3)(4)(5). In particular, the application of first-pass techniques to each pixel of an image to produce an accurate blood flow map allows visualization of regional differences in blood flow with relatively high resolution, and is a noninvasive approach of assessing the severity of coronary artery blockage (6 -9).…”

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confidence: 99%

Fast mapping of myocardial blood flow with MR first‐pass perfusion imaging

Goldstein

Jerosch‐Herold

Misselwitz³

et al. 2008

Magnetic Resonance in Med

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Accurate and fast quantification of myocardial blood flow (MBF) with MR first-pass perfusion imaging techniques on a pixel-bypixel basis remains difficult due to relatively long calculation times and noise-sensitive algorithms. In this study, Zierler's central volume principle was used to develop an algorithm for the calculation of MBF with few assumptions on the shapes of residue curves. Simulation was performed to evaluate the accuracy of this algorithm in the determination of MBF. To examine our algorithm in vivo, studies were performed in nine normal dogs. Two first-pass perfusion imaging sessions were performed with the administration of the intravascular contrast agent Gadomer at rest and during dipyridamole-induced vasodilation. Radiolabeled microspheres were injected to measure MBF at the same time. MBF measurements in dogs using MR methods correlated well with the microsphere measurements (R 2 ‫؍‬ 0.96, slope ‫؍‬ 0.9), demonstrating a fair accuracy in the perfusion measurements at rest and during the vasodilation stress. In addition to its accuracy, this method can also be optimized to run relatively fast, providing potential for fast and Quantification of myocardial blood flow (MBF) has been shown to be an effective tool for diagnosing blood flow defects (regional or global myocardium) and monitoring the effectiveness of therapeutic treatment (1-5). In particular, the application of first-pass techniques to each pixel of an image to produce an accurate blood flow map allows visualization of regional differences in blood flow with relatively high resolution, and is a noninvasive approach of assessing the severity of coronary artery blockage (6 -9).MBF is quantified by deconvolving tissue residue curves measured by dynamic first-pass images and by finding the peak of the resulting impulse response. Consequently, the accuracy of a first-pass algorithm depends largely on its ability to represent a wide variety of impulse response curves. For this reason, model-independent algorithms (10,11), which make few assumptions about the shape of the impulse response, are advantageous. However, because model-independent algorithms require curve-fitting of many parameters, they require special techniques to control noise susceptibility (10). One common way of stabilizing these methods is to introduce a set of smoothing constraints with a weight that depends on the noise level of the data. This "regularization method" is similar to applying a low-pass filter (10). While this technique substantially improves the conditioning of the deconvolution, it increases computation time and strong regularization can lead to underestimation of parameters to be measured.In this study we investigated a new model-independent technique that can be performed with relatively few parameters and does not require regularization. Like other quantification methods it utilizes a deconvolution based on Zierler's central volume principle. However, by choosing a simple representation of the impulse response curve we can achieve low noise sensiti...

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mentioning

confidence: 99%

Fast mapping of myocardial blood flow with MR first‐pass perfusion imaging

Goldstein

Jerosch‐Herold

Misselwitz³

et al. 2008

Magnetic Resonance in Med

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“…Debido a la introducción de equipos con la capacidad de obtener imágenes con tiempos de adquisición muy cortos se ha conseguido visualizar con excelente resolución espacial la llegada y distribución del contraste en el miocardio ventricular [43,44]. Además de evaluar visualmente la perfusión regional miocárdica, nos permite realizar un análisis cuantitativo de la misma [44][45][46].…”

Section: Perfusión De Primer Pasounclassified

“…Se consideró que un segmento muestra RTG cuando muestra una intensidad de señal > 2 desviaciones estándar con respecto a segmentos remotos no infartados. El tamaño del infarto de VI se definió como el porcentaje de masa del VI que muestra RTG en g/m 2 , [40,46]. Para el análisis dicotómico se consideró anormal aquel segmento que muestre una captación tardía de contraste ≥ 50%.…”

Section: Análisis De La Extensión De La Necrosis Transmuralunclassified

“…En otro trabajo realizado por nuestro grupo [46], se estudió la evolución de la perfusión de primer paso durante los primeros 6 meses después del IAM en 40 pacientes con un primer IAMEST, enfermedad de un solo vaso y flujo TIMI 3 tras revascularización. Tanto en la primera semana como a los 6 meses del IAM, los segmentos con perfusión normal mostraron mayor engrosamiento, reserva contráctil y espesor, y menor grado de necrosis transmural.…”

Section: Perfusión De Primer Pasounclassified

“…La presencia de obstrucción microvascular tiene gran importancia tras un IAMEST, y hay numerosos datos que avalan el valor de la obstrucción microvascular en las secuencias de captación tardía, definida como un área de hipocaptación de contraste en el interior de un área de hipercaptación, como predictora de la recuperación de la función sistólica [41,46].…”

Section: Obstrucción Microvascularunclassified

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Caracterización del infarto de miocardio por RM.Cuantificación de parámetros morfológicos y funcionales.

Mendoza¹,

Fabián²

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Head to head comparison of quantitative versus visual analysis of contrast CMR in the setting of myocardial stunning after STEMI: implications on late systolic function and patient outcome

Hüsser

Bodı́

Sanchís

et al. 2010

Int J Cardiovasc Imaging

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To compare a quantitative assessment of contrast cardiovascular magnetic resonance (CMR) after ST-segment elevation myocardial infarction (STEMI) with visual analysis for predicting depressed ejection fraction (dEF) and major adverse cardiac events (MACE). 192 patients underwent CMR at 1 week and 6 months after STEMI. Three quantitative (initial slope, maximal signal intensity and contrast delay in first-pass imaging) and 2 visual perfusion indexes (hypoenhancement in first-pass and microvascular obstruction in late enhancement imaging (LE)) were determined. Quantification of infarct mass and visual assessment of the extent of transmural necrosis (ETN) were also performed. At 6 months, 69 patients displayed dEF. During follow-up (mean 655 days) 20 MACE (death, re-infarction, re-admission for heart failure) occurred. Perfusion quantification took longer (P < 0.001) and, in ROC curve analyses and the C-statistic, was not superior to visual perfusion analysis for predicting late EF or MACE (P = ns). Similarly, infarct size quantification was not superior to visual assessment of ETN (P = ns). In multivariate analyses, only visual assessment of ETN (per segment) predicted dEF (OR 1.30 95%CI [1.04-1.61], P = 0.02) and MACE (HR 1.38 95%CI [1.19-1.60], P < 0.001). Visual analysis of CMR after STEMI is not time consuming and predicts dEF and MACE comparable to quantification. ETN was the strongest parameter.

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Microvascular perfusion 1 week and 6 months after myocardial infarction by first-pass perfusion cardiovascular magnetic resonance imaging

Cited by 36 publications

References 19 publications

Fast mapping of myocardial blood flow with MR first‐pass perfusion imaging

Fast mapping of myocardial blood flow with MR first‐pass perfusion imaging

Caracterización del infarto de miocardio por RM.Cuantificación de parámetros morfológicos y funcionales.

Head to head comparison of quantitative versus visual analysis of contrast CMR in the setting of myocardial stunning after STEMI: implications on late systolic function and patient outcome

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