Usefulness of a Comprehensive Cardiovascular Magnetic Resonance Imaging Assessment for Predicting Recovery of Left Ventricular Wall Motion in the Setting of Myocardial Stunning

Abstract

A comprehensive analysis of the four more widely used CMR-derived viability indexes is useful for predicting late systolic function after myocardial infarction.

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

“…18 Regional wall motion was determined on cine MRI and was considered as abnormal if wall thickening (end-systolic thickness -end-diastolic thickness) was less than 2 mm. 19, 20 The presence or absence of myocardial edema on T2W MRI was determined by the consensus of 3 experienced readers (2 cardiologists and 1 radiologist) who were blinded to the patient's identity. For the assessment of myocardial edema on T2W MRI, the ratio of the mean SI of myocardium compared with that of the skeletal muscle was used and edema was considered to be present if the ratio was more than 2.0.…”

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

“…We have confirmed that early after STEMI, LGE overestimates IS despite using full-width half-maximum quantification, which gives lower values than 2 SD thresholding used by most previous studies. [6][7][8][9]16 Functional improvement occurred in a significant proportion of near-transmurally enhanced segments although only 5% normalized. A key aim of conducting this study was to assess whether the accuracy of LGE to predict functional recovery after STEMI could be improved with the addition of other markers of myocardial injury.…”

“…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][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.…”

Value of Early Cardiovascular Magnetic Resonance for the Prediction of Adverse Arrhythmic Cardiac Events After a First Noncomplicated ST-Segment–Elevation Myocardial Infarction

“…CMR was performed on the basis of an ongoing registry focused on the analysis of the structural consequences of STEMI. [12][13][14] Images were acquired by a phased-array body surface coil during breath hold and were ECG triggered. Cine images (true fast imaging with steady-state precession; repetitions time/echo time: 3.2/1.6 ms; flip angle: 61°; matrix: 256×256; slice thickness: 6 mm; temporal resolution: 26 ms; retrospective acquisition) were acquired at rest in 2-, 3-, and 4-chamber views and every 1 cm in short-axis views.…”

“…It could be explained by different reasons: first, LVEF has a dynamic behavior after STEMI, and the extent of the scar has been demonstrated to help for predicting the absence of late systolic function recovery 12,13 ; second, a big scar predicts inducibility of VT in an electrophysiological study, 11 and it has been related to the appearance of electric instability 19 and, more importantly, to adverse 14 that seems to be necessary for the development of slow conduction and VT substrate. 20 Some studies 7,8 performed in patients with chronic ischemic disease found that scar's heterogeneity or the so-called gray zone best predicted arrhythmic events.…”