Standardizing the Definition of Hyperenhancement in the Quantitative Assessment of Infarct Size and Myocardial Viability Using Delayed Contrast-Enhanced CMR

Bondarenko, Olga; Beek, Aernout M.; Hofman, Mark B.M.; Kühl, Harald P.; Twisk, Jos W. R.; Dockum, Willem G. van; Visser, Cees A.; Rossum, Albert C. van

doi:10.1081/jcmr-200053623

Cited by 356 publications

(257 citation statements)

References 19 publications

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“…The infarction was defined as the hyperenhanced myocardium on the delayed gadolinium‐enhanced short‐axis images. A myocardial area was regarded as hyperenhanced when the signal intensity was >5 SDs of the mean intensity of normal reference myocardium 27. Using CVI 42 (Circle Cardiovascular Imaging Inc.), an area of at least 10 pixels in the remote normal myocardium was used as a reference value for the normal signal intensity.…”

Section: Methodsmentioning

confidence: 99%

Left Ventricular Hypertrophy Is Associated With Increased Infarct Size and Decreased Myocardial Salvage in Patients With ST‐Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Nepper‐Christensen

Lønborg

Ahtarovski

et al. 2017

JAHA

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BackgroundApproximately one third of patients with ST‐segment elevation myocardial infarction (STEMI) have left ventricular hypertrophy (LVH), which is associated with impaired outcome. However, the causal association between LVH and outcome in STEMI is unknown. We evaluated the association between LVH and: myocardial infarct size, area at risk, myocardial salvage, microvascular obstruction, left ventricular (LV) function (all determined by cardiac magnetic resonance [CMR]), and all‐cause mortality and readmission for heart failure in STEMI patients treated with primary percutaneous coronary intervention.Methods and ResultsIn this substudy of the DANAMI‐3 trial, 764 patients underwent CMR. LVH was defined by CMR and considered present if LV mass exceeded 77 (men) and 67 g/m2 (women). One hundred seventy‐eight patients (24%) had LVH. LVH was associated with a larger final infarct size (15% [interquartile range {IQR}, 10–21] vs 9% [IQR, 3–17]; P<0.001) and smaller final myocardial salvage index (0.6 [IQR, 0.5–0.7] vs 0.7 [IQR, 0.5–0.9]; P<0.001). The LVH group had a higher incidence of microvascular obstruction (66% vs 45%; P<0.001) and lower final LV ejection fraction (LVEF; 53% [IQR, 47–60] vs 61% [IQR, 55–65]; P<0.001). In a Cox regression analysis, LVH was associated with a higher risk of all‐cause mortality and readmission for heart failure (hazard ratio 2.59 [95% CI, 1.38–4.90], P=0.003). The results remained statistically significant in multivariable models.ConclusionsLVH is independently associated with larger infarct size, less myocardial salvage, higher incidence of microvascular obstruction, lower LVEF, and a higher risk of all‐cause mortality and incidence of heart failure in STEMI patients treated with primary percutaneous coronary intervention.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT01435408.

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Section: Methodsmentioning

confidence: 99%

Left Ventricular Hypertrophy Is Associated With Increased Infarct Size and Decreased Myocardial Salvage in Patients With ST‐Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Nepper‐Christensen

Lønborg

Ahtarovski

et al. 2017

JAHA

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“…17 However, the thresholds used in Eitel's study were adopted from a previous study in patients with AMI. 22 In our current study, the SI characteristics of LGE lesions were compared between TC and AMI patients. As demonstrated in Figure 3, a CNR value of 4 seems to be meaningful and optimal for differentiating between TC and AMI with a sensitivity of 100% and specificity of 94%.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Signal Characteristics of Late Gadolinium Enhancement on Contrast-Enhanced Magnetic Resonance Imaging in Patients With Takotsubo Cardiomyopathy

Nakamori

Matsuoka

Onishi

et al. 2012

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp akotsubo cardiomyopathy (TC) is a cardiovascular event characterized by acute chest pain with ST-segment elevation and/or T-wave inversion, absence of substantial coronary arterial narrowing on angiography, and reversible systolic dysfunction with abnormal wall motion of the mid and distal left ventricle. 1-3 Cardiac magnetic resonance imaging (MRI) has emerged as a non-invasive imaging modality that permits assessment of myocardial infarction and edema, as well as left ventricular (LV) function. 4-6 In most of the previous studies that have evaluated MRI findings of TC, 7-12 the absence of late gadolinium enhancement (LGE) was considered to be an important finding to differentiate TC from acute myocardial infarction (AMI) in patients with acute chest pain. Recently, several reports indicated that TC may exhibit LGE in the acute phase. 13-16 In a recent multicenter study evaluating TC patients in Europe and the United States, LGE was detected in 9% of TC patients, by using a threshold of 3 standard deviations (SD) above the mean of remote normal myocardium to define the presence of LGE. 17 However, the signal intensity (SI) characteristics of LGE in TC were not well defined in comparison with AMI in those previous studies. In addition, limited data are currently available regarding the prevalence of LGE in TC patients in Japan. Accordingly, the purpose of our study was to determine the SI characteristics of LGE in patients with TC in comparison with AMI, and to evaluate the relationship between the presence of LGE and recovery of wall motion abnormality (WMA). Editorial p 814 MethodsPatients With TC All examinations were approved by the institution's board of medical ethics and clinical investigation and all subjects gave written informed consent. We enrolled 28 consecutive patients

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“…Remote myocardium was identified as the region that showed no hyperintensity on LGE images. Infarcted myocardium was defined as the region with mean signal intensity (SI) that is at least 5 standard deviations greater than that of a reference region of interest (ROI) drawn in remote myocardium (31) (Fig E2 [online]). …”

Section: Patient Studiesmentioning

confidence: 99%

Detection of Acute Reperfusion Myocardial Hemorrhage with Cardiac MR Imaging: T2 versus T2*

Kali

Tang²,

Kumar³

et al. 2013

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Purpose:To evaluate T2 and T2* changes in acute reperfused hemorrhagic and nonhemorrhagic myocardial infarctions and to determine which technique is more suitable in the detection of intramyocardial hemorrhage at 1.5 T. Materials and Methods:Patient studies were approved by the institutional review board and were HIPAA compliant. Patients (n = 14, three women) with first ST-elevation myocardial infarction underwent cardiac magnetic resonance (MR) imaging 3 days after angioplasty. T2* maps, T2 short inversion time inversion-recovery (STIR) images, and late gadolinium enhancement (LGE) images were acquired. Animal studies were approved by the institutional animal care and use committee. Canines (n = 20) were subjected to ischemia-reperfusion injury, and cardiac MR imaging was performed 5 days after reperfusion. T2* and T2 maps and T2 STIR and LGE images were acquired. Repeated-measures analysis of variance or the Friedman test was used to compare T2 and T2* changes in patients with hemorrhagic infarctions and those with nonhemorrhagic infarctions. Results:Relative to remote myocardium, mean T2* of hemorrhagic infarctions was 54% 6 13 (standard deviation) lower in patients (15.9 msec 6 4.5 vs 35.2 msec 6 2.1, P , .001) and 40% 6 10 lower in canines (23.0 msec 6 4.0 vs 39.3 msec 6 2.5, P , .001). Mean T2* of nonhemorrhagic infarctions was marginally elevated by 6% 6 2.5 (37.8 msec 6 2.5, P = .021) in patients and by 8% 6 5 (44.6 msec 6 4.8, P = .012) in canines. In contrast, mean T2 STIR signal intensity (SI) of both hemorrhagic infarctions and nonhemorrhagic infarctions was higher than that in remote myocardium both in patients (hemorrhagic: 37% 6 19, P , .001; nonhemorrhagic: 78% 6 27, P , .001) and in canines (hemorrhagic: 42% 6 22, P , .001; nonhemorrhagic: 65% 6 22, P , .001). Consistent with STIR SI findings, mean T2 of both hemorrhagic (62.0 msec 6 4.9) and nonhemorrhagic (71.7 msec 6 7.3) infarctions in canines was elevated relative to mean T2 of remote myocardium (52.1 msec 6 4.8) by 18% 6 9 and 38% 6 13, respectively (P , .001 for both). Conclusion

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Standardizing the Definition of Hyperenhancement in the Quantitative Assessment of Infarct Size and Myocardial Viability Using Delayed Contrast-Enhanced CMR

Cited by 356 publications

References 19 publications

Left Ventricular Hypertrophy Is Associated With Increased Infarct Size and Decreased Myocardial Salvage in Patients With ST‐Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Left Ventricular Hypertrophy Is Associated With Increased Infarct Size and Decreased Myocardial Salvage in Patients With ST‐Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Prevalence and Signal Characteristics of Late Gadolinium Enhancement on Contrast-Enhanced Magnetic Resonance Imaging in Patients With Takotsubo Cardiomyopathy

Detection of Acute Reperfusion Myocardial Hemorrhage with Cardiac MR Imaging: T2 versus T2*

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