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Imaging of reperfused intramyocardial hemorrhage with cardiovascular magnetic resonance susceptibility weighted imaging (SWI). PLoS One 2015; 10:e0123560. [PMID: 25875478 PMCID: PMC4395374 DOI: 10.1371/journal.pone.0123560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 03/04/2015] [Indexed: 01/24/2023] Open
Abstract
Purpose To report initial experience with TE-averaged susceptibility weighted imaging (SWI) in normal subjects and acute myocardial infarction (AMI) patients for the detection of intramyocardial hemorrhage (IMH). Materials and Methods 15 healthy control and 11 AMI subjects were studied at 1.5T before contrast agent administration with a dark blood double inversion recovery multiple spoiled gradient-echo sequence. Magnitude, susceptibility weighted and TE-averaged images were reconstructed from raw data. Contrast and signal-difference-to-noise were measured and compared between methods for IMH detection. Results There were six patients with microvascular obstruction (MVO) and four patients with IMH detected by TE-averaged SWI imaging. All patients with IMH on SWI scans had MVO on late gadolinium-enhanced (LGE) imaging. There was a three-fold increase in IMH contrast with SWI compared to magnitude images. IMH contrast decreased and signal-to-noise increased with increased TE averages. Conclusions TE-averaged SWI imaging is a promising method for myocardial tissue characterization in the setting of AMI for the detection of IMH. Along with gray-scale colormap inversion, it combines not only magnitude and phase information, but also images across TEs to provide a single image sensitive to IMH with characteristics similar to LGE imaging.
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Nensa F, Poeppel T, Tezgah E, Heusch P, Nassenstein K, Mahabadi AA, Forsting M, Bockisch A, Erbel R, Heusch G, Schlosser T. Integrated FDG PET/MR Imaging for the Assessment of Myocardial Salvage in Reperfused Acute Myocardial Infarction. Radiology 2015; 276:400-7. [PMID: 25848898 DOI: 10.1148/radiol.2015140564] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To compare the size of the area with reduced myocardial fluorodeoxygluose (FDG) uptake with the endocardial surface area (ESA) method as a marker for the area at risk in patients with reperfused acute myocardial infarction. MATERIALS AND METHODS The study was approved by the local institutional review board. All patients gave written informed consent prior to their examination. Twenty-five patients (mean age ± standard deviation, 54 years ± 14) underwent prospective cardiac positron emission tomography/magnetic resonance imaging after acute coronary occlusion and interventional reperfusion. On late gadolinium contrast enhancement images, the size of infarction and the area at risk, as determined with ESA, were assessed and compared with the area of reduced FDG uptake. Statistical analysis comprised paired t tests and Mann-Whitney U tests, as well as Pearson r and Spearman ρ for correlations. RESULTS In patients with infarcted myocardium and reduced FDG uptake (n = 18), a good correlation between the area of reduced FDG uptake and the area at risk according to ESA was observed (r = .70, P = .001). The area of reduced FDG uptake (31% ± 11 of left ventricular myocardial mass) was larger than the size of the infarct (10% ± 10, P < .0001) and the area at risk according to ESA (17% ± 13, P < .0001). In six patients, no late contrast enhancement was seen, whereas all patients had an area of reduced FDG uptake (29% ± 8) in the perfusion territory of the culprit artery. CONCLUSION In patients with reperfused acute myocardial infarction, the area of reduced FDG uptake correlates with the area at risk as determined with the ESA method and is localized in the perfusion territory of the culprit artery in the absence of necrosis, although the area of reduced FDG uptake largely overestimates the size of the infarct and the ESA-based area at risk.
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Affiliation(s)
- Felix Nensa
- From the Department of Diagnostic and Interventional Radiology and Neuroradiology (F.N., K.N., M.F., T.S.), Clinic for Nuclear Medicine (T.P., A.B.), Clinic for Cardiology (E.T., A.A.M., R.E.), and Institute for Pathophysiology (G.H.), University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany; and Department of Diagnostic and Interventional Radiology, University Hospital Dusseldorf, University of Dusseldorf, Dusseldorf, Germany (P.H.)
| | - Thorsten Poeppel
- From the Department of Diagnostic and Interventional Radiology and Neuroradiology (F.N., K.N., M.F., T.S.), Clinic for Nuclear Medicine (T.P., A.B.), Clinic for Cardiology (E.T., A.A.M., R.E.), and Institute for Pathophysiology (G.H.), University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany; and Department of Diagnostic and Interventional Radiology, University Hospital Dusseldorf, University of Dusseldorf, Dusseldorf, Germany (P.H.)
| | - Ercan Tezgah
- From the Department of Diagnostic and Interventional Radiology and Neuroradiology (F.N., K.N., M.F., T.S.), Clinic for Nuclear Medicine (T.P., A.B.), Clinic for Cardiology (E.T., A.A.M., R.E.), and Institute for Pathophysiology (G.H.), University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany; and Department of Diagnostic and Interventional Radiology, University Hospital Dusseldorf, University of Dusseldorf, Dusseldorf, Germany (P.H.)
| | - Philipp Heusch
- From the Department of Diagnostic and Interventional Radiology and Neuroradiology (F.N., K.N., M.F., T.S.), Clinic for Nuclear Medicine (T.P., A.B.), Clinic for Cardiology (E.T., A.A.M., R.E.), and Institute for Pathophysiology (G.H.), University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany; and Department of Diagnostic and Interventional Radiology, University Hospital Dusseldorf, University of Dusseldorf, Dusseldorf, Germany (P.H.)
| | - Kai Nassenstein
- From the Department of Diagnostic and Interventional Radiology and Neuroradiology (F.N., K.N., M.F., T.S.), Clinic for Nuclear Medicine (T.P., A.B.), Clinic for Cardiology (E.T., A.A.M., R.E.), and Institute for Pathophysiology (G.H.), University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany; and Department of Diagnostic and Interventional Radiology, University Hospital Dusseldorf, University of Dusseldorf, Dusseldorf, Germany (P.H.)
| | - Amir A Mahabadi
- From the Department of Diagnostic and Interventional Radiology and Neuroradiology (F.N., K.N., M.F., T.S.), Clinic for Nuclear Medicine (T.P., A.B.), Clinic for Cardiology (E.T., A.A.M., R.E.), and Institute for Pathophysiology (G.H.), University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany; and Department of Diagnostic and Interventional Radiology, University Hospital Dusseldorf, University of Dusseldorf, Dusseldorf, Germany (P.H.)
| | - Michael Forsting
- From the Department of Diagnostic and Interventional Radiology and Neuroradiology (F.N., K.N., M.F., T.S.), Clinic for Nuclear Medicine (T.P., A.B.), Clinic for Cardiology (E.T., A.A.M., R.E.), and Institute for Pathophysiology (G.H.), University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany; and Department of Diagnostic and Interventional Radiology, University Hospital Dusseldorf, University of Dusseldorf, Dusseldorf, Germany (P.H.)
| | - Andreas Bockisch
- From the Department of Diagnostic and Interventional Radiology and Neuroradiology (F.N., K.N., M.F., T.S.), Clinic for Nuclear Medicine (T.P., A.B.), Clinic for Cardiology (E.T., A.A.M., R.E.), and Institute for Pathophysiology (G.H.), University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany; and Department of Diagnostic and Interventional Radiology, University Hospital Dusseldorf, University of Dusseldorf, Dusseldorf, Germany (P.H.)
| | - Raimund Erbel
- From the Department of Diagnostic and Interventional Radiology and Neuroradiology (F.N., K.N., M.F., T.S.), Clinic for Nuclear Medicine (T.P., A.B.), Clinic for Cardiology (E.T., A.A.M., R.E.), and Institute for Pathophysiology (G.H.), University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany; and Department of Diagnostic and Interventional Radiology, University Hospital Dusseldorf, University of Dusseldorf, Dusseldorf, Germany (P.H.)
| | - Gerd Heusch
- From the Department of Diagnostic and Interventional Radiology and Neuroradiology (F.N., K.N., M.F., T.S.), Clinic for Nuclear Medicine (T.P., A.B.), Clinic for Cardiology (E.T., A.A.M., R.E.), and Institute for Pathophysiology (G.H.), University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany; and Department of Diagnostic and Interventional Radiology, University Hospital Dusseldorf, University of Dusseldorf, Dusseldorf, Germany (P.H.)
| | - Thomas Schlosser
- From the Department of Diagnostic and Interventional Radiology and Neuroradiology (F.N., K.N., M.F., T.S.), Clinic for Nuclear Medicine (T.P., A.B.), Clinic for Cardiology (E.T., A.A.M., R.E.), and Institute for Pathophysiology (G.H.), University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany; and Department of Diagnostic and Interventional Radiology, University Hospital Dusseldorf, University of Dusseldorf, Dusseldorf, Germany (P.H.)
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McAlindon EJ, Pufulete M, Harris JM, Lawton CB, Moon JC, Manghat N, Hamilton MCK, Weale PJ, Bucciarelli-Ducci C. Measurement of Myocardium at Risk with Cardiovascular MR: Comparison of Techniques for Edema Imaging. Radiology 2015; 275:61-70. [DOI: 10.1148/radiol.14131980] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ibáñez B, Heusch G, Ovize M, Van de Werf F. Evolving Therapies for Myocardial Ischemia/Reperfusion Injury. J Am Coll Cardiol 2015; 65:1454-71. [DOI: 10.1016/j.jacc.2015.02.032] [Citation(s) in RCA: 527] [Impact Index Per Article: 58.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 02/22/2015] [Indexed: 12/28/2022]
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Montant P, Sigovan M, Revel D, Douek P. MR imaging assessment of myocardial edema with T2 mapping. Diagn Interv Imaging 2015; 96:885-90. [PMID: 25697831 DOI: 10.1016/j.diii.2014.07.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 06/27/2014] [Accepted: 07/04/2014] [Indexed: 11/26/2022]
Abstract
Cardiac magnetic resonance (CMR) provides a high signal-to-noise ratio, high spatial and temporal resolutions, as well as a delayed-enhancement sequence and is therefore considered a reference technique in the field of cardiac imaging. However, currently available sequences are not adequate to assess some pathologic conditions, such as myocardial edema. T2 mapping sequences generate parametric images that are based on the transverse relaxation time (T2) for each voxel. In case of edema, the T2 relaxation time is longer. This review summarizes current knowledge on CMR T2 mapping for assessing myocardial edema.
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Affiliation(s)
- P Montant
- Department of Cardiology, centre hospitalier Alpes-Léman, 558, route de Findrol, 74130 Contamine-sur-Arve, France
| | - M Sigovan
- Pôle d'activité médicale imagerie, Hospices Civils de Lyon, 28, avenue Doyen-Lépine, 69677 Bron cedex, France.
| | - D Revel
- Department of Radiology, hôpital Louis-Pradel, 28, avenue Doyen-Lépine, 69677 Bron cedex, France
| | - P Douek
- Department of Radiology, hôpital Louis-Pradel, 28, avenue Doyen-Lépine, 69677 Bron cedex, France
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Matsumoto H, Matsuda T, Miyamoto K, Shimada T, Ushimaru S, Mikuri M, Yamazaki T. Temporal change of enhancement after gadolinium injection on contrast-enhanced CMR in reperfused acute myocardial infarction. J Cardiol 2015; 65:76-81. [DOI: 10.1016/j.jjcc.2014.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 04/05/2014] [Accepted: 04/10/2014] [Indexed: 12/01/2022]
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Garcia-Dorado D, García-del-Blanco B, Otaegui I, Rodríguez-Palomares J, Pineda V, Gimeno F, Ruiz-Salmerón R, Elizaga J, Evangelista A, Fernandez-Avilés F, San-Román A, Ferreira-González I. Intracoronary injection of adenosine before reperfusion in patients with ST-segment elevation myocardial infarction: A randomized controlled clinical trial. Int J Cardiol 2014; 177:935-41. [DOI: 10.1016/j.ijcard.2014.09.203] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 09/16/2014] [Accepted: 09/30/2014] [Indexed: 12/12/2022]
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Fernández-Jiménez R, Sánchez-González J, Agüero J, García-Prieto J, López-Martín GJ, García-Ruiz JM, Molina-Iracheta A, Rosselló X, Fernández-Friera L, Pizarro G, García-Álvarez A, Dall'Armellina E, Macaya C, Choudhury RP, Fuster V, Ibáñez B. Myocardial edema after ischemia/reperfusion is not stable and follows a bimodal pattern: imaging and histological tissue characterization. J Am Coll Cardiol 2014; 65:315-323. [PMID: 25460833 DOI: 10.1016/j.jacc.2014.11.004] [Citation(s) in RCA: 173] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 11/05/2014] [Accepted: 11/06/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND It is widely accepted that edema occurs early in the ischemic zone and persists in stable form for at least 1 week after myocardial ischemia/reperfusion. However, there are no longitudinal studies covering from very early (minutes) to late (1 week) reperfusion stages confirming this phenomenon. OBJECTIVES This study sought to perform a comprehensive longitudinal imaging and histological characterization of the edematous reaction after experimental myocardial ischemia/reperfusion. METHODS The study population consisted of 25 instrumented Large-White pigs (30 kg to 40 kg). Closed-chest 40-min ischemia/reperfusion was performed in 20 pigs, which were sacrificed at 120 min (n = 5), 24 h (n = 5), 4 days (n = 5), and 7 days (n = 5) after reperfusion and processed for histological quantification of myocardial water content. Cardiac magnetic resonance (CMR) scans with T2-weighted short-tau inversion recovery and T2-mapping sequences were performed at every follow-up stage until sacrifice. Five additional pigs sacrificed after baseline CMR served as controls. RESULTS In all pigs, reperfusion was associated with a significant increase in T2 relaxation times in the ischemic region. On 24-h CMR, ischemic myocardium T2 times returned to normal values (similar to those seen pre-infarction). Thereafter, ischemic myocardium-T2 times in CMR performed on days 4 and 7 after reperfusion progressively and systematically increased. On day 7 CMR, T2 relaxation times were as high as those observed at reperfusion. Myocardial water content analysis in the ischemic region showed a parallel bimodal pattern: 2 high water content peaks at reperfusion and at day 7, and a significant decrease at 24 h. CONCLUSIONS Contrary to the accepted view, myocardial edema during the first week after ischemia/reperfusion follows a bimodal pattern. The initial wave appears abruptly upon reperfusion and dissipates at 24 h. Conversely, the deferred wave of edema appears progressively days after ischemia/reperfusion and is maximal around day 7 after reperfusion.
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Affiliation(s)
- Rodrigo Fernández-Jiménez
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Javier Sánchez-González
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Philips Healthcare, Madrid, Spain
| | - Jaume Agüero
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | - Jaime García-Prieto
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | | | - José M García-Ruiz
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | | | - Xavier Rosselló
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | - Leticia Fernández-Friera
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Hospital Universitario Montepríncipe, Madrid, Spain
| | - Gonzalo Pizarro
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Hospital Universitario Quirón Universidad Europea de Madrid, Madrid, Spain
| | - Ana García-Álvarez
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | - Erica Dall'Armellina
- Oxford Acute Vascular Imaging Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Carlos Macaya
- Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Robin P Choudhury
- Oxford Acute Vascular Imaging Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Valentin Fuster
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Borja Ibáñez
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Hospital Universitario Clínico San Carlos, Madrid, Spain.
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Cardiac magnetic resonance imaging for ischemic heart disease: update on diagnosis and prognosis. Top Magn Reson Imaging 2014; 23:21-31. [PMID: 24509621 DOI: 10.1097/rmr.0000000000000014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Despite significant advancements in the treatment of ischemic heart disease (IHD), IHD remains a leading cause of mortality and morbidity. In addition, there remains clinical equipoise regarding a number of important management issues across the spectrum of IHD, from evaluating patients with chest pain in the emergency department, to deciding whether patients with chronic stable angina or severe ischemic cardiomyopathies should undergo invasive revascularization procedures. Recent data over the past 2 decades has demonstrated that cardiac magnetic resonance imaging is highly accurate and carries robust prognostic value in the evaluation of patients with both acute and chronic IHD. The combination of cine imaging for cardiac structure and function, late gadolinium enhancement imaging of myocardial scar, qualitative and quantitative measures of myocardial fibrosis, and stress perfusion imaging for the presence and extent of ischemia provides a comprehensive and detailed characterization of cardiac anatomy and physiology that guides critical treatment decisions for patients. This review aims to cover both the diagnostic and prognostic utility of cardiac magnetic resonance imaging for the spectrum of IHD.
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Feng Y, Bogaert J, Oyen R, Ni Y. An overview on development and application of an experimental platform for quantitative cardiac imaging research in rabbit models of myocardial infarction. Quant Imaging Med Surg 2014; 4:358-75. [PMID: 25392822 PMCID: PMC4213418 DOI: 10.3978/j.issn.2223-4292.2013.09.01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 09/05/2013] [Indexed: 12/28/2022]
Abstract
To exploit the advantages of using rabbits for cardiac imaging research and to tackle the technical obstacles, efforts have been made under the framework of a doctoral research program. In this overview article, by cross-referencing the current literature, we summarize how we have developed a preclinical cardiac research platform based on modified models of reperfused myocardial infarction (MI) in rabbits; how the in vivo manifestations of cardiac imaging could be closely matched with those ex vivo macro- and microscopic findings; how these imaging outcomes could be quantitatively analyzed, validated and demonstrated; and how we could apply this cardiac imaging platform to provide possible solutions to certain lingering diagnostic and therapeutic problems in experimental cardiology. In particular, tissue components in acute cardiac ischemia have been stratified and characterized, post-infarct lipomatous metaplasia (LM) as a common but hardly illuminated clinical pathology has been identified in rabbit models, and a necrosis avid tracer as well as an anti-ischemic drug have been successfully assessed for their potential utilities in clinical cardiology. These outcomes may interest the researchers in the related fields and help strengthen translational research in cardiovascular diseases.
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Affiliation(s)
- Yuanbo Feng
- KU Leuven, Department of Imaging and Pathology, Theragnostic Laboratory, Radiology Section, University Hospital Gasthuisberg, Leuven, Belgium
| | - Jan Bogaert
- KU Leuven, Department of Imaging and Pathology, Theragnostic Laboratory, Radiology Section, University Hospital Gasthuisberg, Leuven, Belgium
| | - Raymond Oyen
- KU Leuven, Department of Imaging and Pathology, Theragnostic Laboratory, Radiology Section, University Hospital Gasthuisberg, Leuven, Belgium
| | - Yicheng Ni
- KU Leuven, Department of Imaging and Pathology, Theragnostic Laboratory, Radiology Section, University Hospital Gasthuisberg, Leuven, Belgium
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Wang L, Wang F, Fang W, Johnson SE, Audi S, Zimmer M, Holly TA, Lee DC, Zhu B, Zhu H, Zhao M. The feasibility of imaging myocardial ischemic/reperfusion injury using (99m)Tc-labeled duramycin in a porcine model. Nucl Med Biol 2014; 42:198-204. [PMID: 25451214 DOI: 10.1016/j.nucmedbio.2014.09.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 07/10/2014] [Accepted: 09/02/2014] [Indexed: 02/08/2023]
Abstract
UNLABELLED When pathologically externalized, phosphatidylethanolamine (PE) is a potential surrogate marker for detecting tissue injuries. (99m)Tc-labeled duramycin is a peptide-based imaging agent that binds PE with high affinity and specificity. The goal of the current study was to investigate the clearance kinetics of (99m)Tc-labeled duramycin in a large animal model (normal pigs) and to assess its uptake in the heart using a pig model of myocardial ischemia-reperfusion injury. METHODS The clearance and distribution of intravenously injected (99m)Tc-duramycin were characterized in sham-operated animals (n=5). In a closed chest model of myocardial ischemia, coronary occlusion was induced by balloon angioplasty (n=9). (99m)Tc-duramycin (10-15mCi) was injected intravenously at 1hour after reperfusion. SPECT/CT was acquired at 1 and 3hours after injection. Cardiac tissues were analyzed for changes associated with acute cellular injuries. Autoradiography and gamma counting were used to determine radioactivity uptake. For the remaining animals, (99m)Tc-tetrafosamin scan was performed on the second day to identify the infarct site. RESULTS Intravenously injected (99m)Tc-duramycin cleared from circulation predominantly via the renal/urinary tract with an α-phase half-life of 3.6±0.3minutes and β-phase half-life of 179.9±64.7minutes. In control animals, the ratios between normal heart and lung were 1.76±0.21, 1.66±0.22, 1.50±0.20 and 1.75±0.31 at 0.5, 1, 2 and 3hours post-injection, respectively. The ratios between normal heart and liver were 0.88±0.13, 0.80±0.13, 0.82±0.19 and 0.88±0.14. In vivo visualization of focal radioactivity uptake in the ischemic heart was attainable as early as 30min post-injection. The in vivo ischemic-to-normal uptake ratios were 3.57±0.74 and 3.69±0.91 at 1 and 3hours post-injection, respectively. Ischemic-to-lung ratios were 4.89±0.85 and 4.93±0.57; and ischemic-to-liver ratios were 2.05±0.30 to 3.23±0.78. The size of (99m)Tc-duramycin positive myocardium was qualitatively larger than the infarct size delineated by the perfusion defect in (99m)Tc-tetrafosmin uptake. This was consistent with findings from tissue analysis and autoradiography. CONCLUSION (99m)Tc-duramycin was demonstrated, in a large animal model, to have suitable clearance and biodistribution profiles for imaging. The agent has an avid target uptake and a fast background clearance. It is appropriate for imaging myocardial injury induced by ischemia/reperfusion.
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Affiliation(s)
- Lei Wang
- Department of Nuclear Medicine, Cardiovascular Institute & Fu Wai Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
| | - Feng Wang
- Department of Nuclear Medicine, Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Wei Fang
- Department of Nuclear Medicine, Cardiovascular Institute & Fu Wai Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
| | - Steven E Johnson
- Department of Medicine, Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Said Audi
- Department of Biomedical Engineering, Marquette University, Milwaukee, WI, USA
| | - Michael Zimmer
- Nuclear Medicine Department, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Thomas A Holly
- Department of Medicine, Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Daniel C Lee
- Department of Medicine, Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Bao Zhu
- Department of Nuclear Medicine, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China.
| | - Haibo Zhu
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.
| | - Ming Zhao
- Department of Medicine, Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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White SK, Frohlich GM, Sado DM, Maestrini V, Fontana M, Treibel TA, Tehrani S, Flett AS, Meier P, Ariti C, Davies JR, Moon JC, Yellon DM, Hausenloy DJ. Remote ischemic conditioning reduces myocardial infarct size and edema in patients with ST-segment elevation myocardial infarction. JACC Cardiovasc Interv 2014; 8:178-188. [PMID: 25240548 DOI: 10.1016/j.jcin.2014.05.015] [Citation(s) in RCA: 185] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 05/19/2014] [Accepted: 05/27/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES This study aimed to determine whether remote ischemic conditioning (RIC) initiated prior to primary percutaneous coronary intervention (PPCI) could reduce myocardial infarct (MI) size in patients presenting with ST-segment elevation myocardial infarction. BACKGROUND RIC, using transient limb ischemia and reperfusion, can protect the heart against acute ischemia-reperfusion injury. Whether RIC can reduce MI size, assessed by cardiac magnetic resonance (CMR), is unknown. METHODS We randomly assigned 197 ST-segment elevation myocardial infarction patients with TIMI (Thrombolysis In Myocardial Infarction) flow grade 0 to receive RIC (four 5-min cycles of upper arm cuff inflation/deflation) or control (uninflated cuff placed on upper arm for 40 min) protocols prior to PPCI. The primary study endpoint was MI size, measured by CMR in 83 subjects on days 3 to 6 after admission. RESULTS RIC reduced MI size by 27%, when compared with the MI size of control subjects (18.0 ± 10% [n = 40] vs. 24.5 ± 12.0% [n = 43]; p = 0.009). At 24 h, high-sensitivity troponin T was lower with RIC (2,296 ± 263 ng/l [n = 89] vs. 2,736 ± 325 ng/l [n = 84]; p = 0.037). RIC also reduced the extent of myocardial edema measured by T2-mapping CMR (28.5 ± 9.0% vs. 35.1 ± 10.0%; p = 0.003) and lowered mean T2 values (68.7 ± 5.8 ms vs. 73.1 ± 6.1 ms; p = 0.001), precluding the use of CMR edema imaging to correctly estimate the area at risk. Using CMR-independent coronary angiography jeopardy scores to estimate the area at risk, RIC, when compared with the control protocol, was found to significantly improve the myocardial salvage index (0.42 ± 0.29 vs. 0.28 ± 0.29; p = 0.03). CONCLUSIONS This randomized study demonstrated that in ST-segment elevation myocardial infarction patients treated by PPCI, RIC, initiated prior to PPCI, reduced MI size, increased myocardial salvage, and reduced myocardial edema.
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Affiliation(s)
- Steven K White
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, National Institute of Health Research University College London Hospitals Biomedical Research Centre, University College London, London, United Kingdom; The Heart Hospital, London, United Kingdom
| | | | | | | | | | | | | | - Andrew S Flett
- Department of Cardiology, University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom
| | | | - Cono Ariti
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - John R Davies
- The Essex Cardiothoracic Centre, Basildon University Hospital, Nethermayne, Basildon, Essex, United Kingdom
| | | | - Derek M Yellon
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, National Institute of Health Research University College London Hospitals Biomedical Research Centre, University College London, London, United Kingdom
| | - Derek J Hausenloy
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, National Institute of Health Research University College London Hospitals Biomedical Research Centre, University College London, London, United Kingdom; The Heart Hospital, London, United Kingdom.
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Affiliation(s)
- Erik B Schelbert
- UPMC Heart and Vascular Institute, Pittsburgh, PA (E.B.S., T.C.W.) UPMC CMR Center, Pittsburgh, PA (E.B.S., T.C.W.) Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA (E.B.S., T.C.W.)
| | - Timothy C Wong
- UPMC Heart and Vascular Institute, Pittsburgh, PA (E.B.S., T.C.W.) UPMC CMR Center, Pittsburgh, PA (E.B.S., T.C.W.) Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA (E.B.S., T.C.W.)
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Niccoli G, Cosentino N, Spaziani C, Loria V, Fracassi F, Roberto M, Calvieri C, Lombardo A, Natale L, Napolitano C, Mandurinoa A, Burzotta F, Leone AM, Porto I, Trani C, Bonomo L, Crea F. Concordance of angiographic and electrocardiographic indexes of microvascular obstruction: myocardial haemorrhage role. J Cardiovasc Med (Hagerstown) 2014; 17:382-91. [PMID: 25083721 DOI: 10.2459/jcm.0000000000000178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Angiographic and electrocardiographic (ECG) indexes of microvascular obstruction (MVO) have been described. We aimed at assessing by cardiac magnetic resonance (CMR) anatomical features underlying concordance between them. METHODS Forty-one patients were enrolled. Patients presented with neither angiographic nor ECG indexes of MVO (without MVO) (44%), with either angiographic or ECG indexes of MVO (discordant with MVO) (22%) or with both angiographic and ECG indexes of MVO (concordant with MVO) (34%). All patients underwent in-hospital CMR. Echocardiographic data obtained after 6 months were compared with those obtained in hospital. RESULTS Concordant patients with MVO had larger infarct size, lower myocardial salvage index and higher rate of myocardial haemorrhage (all assessed by CMR) [33% (25-41%), 15% (10-29%) and 88%, respectively] as compared with patients without MVO [12% (9-16%), 66% (52-79%) and 0%; Bonferroni-adjusted P < 0.001, Bonferroni-adjusted P < 0.001 and P < 0.001, respectively], or with discordant ones [25% (21-39%), 35% (20-48%) and 7%; Bonferroni-adjusted P = 0.03, Bonferroni-adjusted P = 0.002 and P = 0.04, respectively]. After 6 months, ejection fraction significantly decreased in concordant patients with MVO (P < 0.001) without significant changes in the other groups. CONCLUSIONS Concordance of angiographic and ECG indexes of MVO reflects more severe myocardial damage translating into unfavourable left ventricular remodelling.
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Affiliation(s)
- Giampaolo Niccoli
- aInstitute of Cardiology, Catholic University of the Sacred Heart bDepartment of Cardiovascular, Respiratory, Nephrologic and Geriatric Sciences Sapienza University of Rome cInstitute of Radiology, Department of Bioimaging and Radiological Sciences, Catholic University, Rome, Italy
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Gimelli A, Masci PG, Liga R, Grigoratos C, Pasanisi EM, Lombardi M, Marzullo P. Regional heterogeneity in cardiac sympathetic innervation in acute myocardial infarction: relationship with myocardial oedema on magnetic resonance. Eur J Nucl Med Mol Imaging 2014; 41:1692-4. [PMID: 24819056 DOI: 10.1007/s00259-014-2792-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 04/24/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE To assess the relationships between myocardial structure and function on cardiac magnetic resonance (CMR) imaging and sympathetic tone on (123)I-metaiodobenzylguanidine ((123)I-MIBG) scintigraphy early after myocardial infarction (MI). METHODS Ten patients underwent (123)I-MIBG and (99m)Tc-tetrofosmin rest cadmium zinc telluride scintigraphy 4 ± 1 days after MI. The segmental left ventricular (LV) relative radiotracer uptake of both (99m)Tc-tetrofosmin and early (123)I-MIBG was calculated. The day after scintigraphy, on CMR imaging, the extent of ischaemia-related oedema and of myocardial fibrosis (late gadolinium enhancement, LGE) was assessed. Accordingly, the extent of oedema and LGE was evaluated for each segment and segmental wall thickening determined. Based on LGE distribution, LV segments were categorized as "infarcted" (56 segments), "adjacent" (66 segments) or "remote" (48 segments). RESULTS Infarcted segments showed a more depressed systolic wall thickening and greater extent of oedema than adjacent segments (p < 0.001) and remote segments (p < 0.001). Interestingly, while uptake of (99m)Tc-tetrofosmin was significantly depressed only in infarcted segments (p < 0.001 vs. both adjacent and remote segments), uptake of (123)I-MIBG was impaired not only in infarcted segments (p < 0.001 vs. remote) but also in adjacent segments (p = 0.024 vs. remote segments). At the regional level, after correction for (99m)Tc-tetrofosmin and LGE distribution, segmental (123)I-MIBG uptake (p < 0.001) remained an independent predictor of ischaemia-related oedema. CONCLUSION After acute MI the regional impairment of sympathetic tone extends beyond the area of altered myocardial perfusion and is associated with myocardial oedema.
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Affiliation(s)
- Alessia Gimelli
- Fondazione CNR/Regione Toscana, Via Moruzzi, 1, 56124, Pisa, Italy,
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Hammer-Hansen S, Ugander M, Hsu LY, Taylor J, Thune JJ, Køber L, Kellman P, Arai AE. Distinction of salvaged and infarcted myocardium within the ischaemic area-at-risk with T2 mapping. Eur Heart J Cardiovasc Imaging 2014; 15:1048-53. [PMID: 24810903 DOI: 10.1093/ehjci/jeu073] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
AIM Area-at-risk (AAR) measurements often rely on T2-weighted images, but subtle differences in T2 may be overlooked with this method. To determine the differences in oedema between salvaged and infarcted myocardium, we performed quantitative T2 mapping of the AAR. We also aimed to determine the impact of reperfusion time on T2 in the AAR. METHODS Twenty-two dogs underwent 2 h of coronary occlusion followed by 4 or 48 h of reperfusion before cardiac magnetic resonance imaging at 1.5 T. Late gadolinium enhancement images were used to define the infarcted, salvaged, and remote myocardium. T2 values from T2 maps and signal intensities on T2-weighted images were measured in the corresponding areas. RESULTS At both imaging time points, the T2 of the salvaged myocardium was longer than of remote (66.0 ± 6.9 vs. 51.4 ± 3.5 ms, P < 0.001 at 4 h, and 56.7 ± 7.3 vs. 48.1 ± 3.5 ms, P < 0.001 at 48 h). The T2 was also longer in the infarcted myocardium compared with remote at both 4 and 48 h (71.4 ± 7.6 ms, P < 0.01 vs. salvage and 64.0 ± 6.9 ms, P = 0.03 vs. salvage, both P < 0.001 vs. remote). The increase in T2 in the salvaged myocardium compared with remote was greater after 4 h than after 48 h (14.7 ± 5.6 vs. 8.7 ± 5.1 ms, P = 0.02). CONCLUSIONS T2 relaxation parameters are different in the infarcted and salvaged myocardium, and both are significantly longer than remote. Furthermore, the magnitude of increase in T2 was less in the salvaged myocardium after longer reperfusion, indicating partial resolution of oedema in the first 48 h after reperfusion.
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Affiliation(s)
- Sophia Hammer-Hansen
- Department of Health and Human Services, Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, 10 Center Drive, Bldg 10, RM B1D416, Bethesda, MD 20892-1061, USA Department of Medicine B, The Heart Center, Rigshospitalet, Copenhagen, Denmark
| | - Martin Ugander
- Department of Clinical Physiology, N2:01, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Li-Yueh Hsu
- Department of Health and Human Services, Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, 10 Center Drive, Bldg 10, RM B1D416, Bethesda, MD 20892-1061, USA
| | - Joni Taylor
- Department of Health and Human Services, Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, 10 Center Drive, Bldg 10, RM B1D416, Bethesda, MD 20892-1061, USA
| | - Jens Jakob Thune
- Department of Medicine B, The Heart Center, Rigshospitalet, Copenhagen, Denmark
| | - Lars Køber
- Department of Medicine B, The Heart Center, Rigshospitalet, Copenhagen, Denmark
| | - Peter Kellman
- Department of Health and Human Services, Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, 10 Center Drive, Bldg 10, RM B1D416, Bethesda, MD 20892-1061, USA
| | - Andrew E Arai
- Department of Health and Human Services, Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, 10 Center Drive, Bldg 10, RM B1D416, Bethesda, MD 20892-1061, USA
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Abstract
Magnetic resonance (MR) imaging plays an important role in evaluation of various aspects of myocardial infarction (MI). MR imaging is useful in establishing the diagnosis of acute MI, particularly in patients who present with symptoms of MI but outside the diagnostic time frame of altered cardiac enzyme levels or with clinical features of acute MI but without an angiographic culprit lesion. MR imaging is valuable in establishing a diagnosis of chronic MI and distinguishing this condition from nonischemic cardiomyopathies, mainly through use of delayed-enhancement patterns. MR imaging also provides clinicians with several prognostic indicators that enable risk stratification, such as scar burden, microvascular obstruction, hemorrhage, and peri-infarct ischemia. The extent and transmurality of scar burden have been shown to have independent and incremental prognostic power over a range of left ventricular function. The extent of scarring at MR imaging is an important predictor of successful outcome after revascularization procedures, and extensive scarring in the lateral wall indicates poor outcome after cardiac resynchronization therapy. Scar size at MR imaging is also a useful surrogate end point in clinical trials. Finally, MR imaging can be used to detect complications of MI, such as aneurysms, pericarditis, ventricular septal defect, thrombus, and mitral regurgitation. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.335125722/-/DC1.
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Affiliation(s)
- Prabhakar Rajiah
- Cardiothoracic Imaging Section, University Hospitals of Cleveland, Case Western Reserve University School of Medicine, Cleveland, Ohio
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Dall’Armellina E, Ferreira V, Neubauer S. T1 Mapping in Ischemic Heart Disease. CURRENT CARDIOVASCULAR IMAGING REPORTS 2014. [DOI: 10.1007/s12410-014-9262-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Fernández-Jiménez R, Fernández-Friera L, Sánchez-González J, Ibáñez B. Animal Models of Tissue Characterization of Area at Risk, Edema and Fibrosis. CURRENT CARDIOVASCULAR IMAGING REPORTS 2014. [DOI: 10.1007/s12410-014-9259-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Abstract
With the advent of thrombolytic therapy and angioplasty, it has become possible to reduce myocardial infarct size through early reperfusion. Enormous effort has been expended to find therapies that can further reduce infarct size after early intervention. Animal studies have identified many cardioprotective pathways that have the potential to reduce infarct size if activated before the onset of ischemia. More recently, interventions effective at the onset of reperfusion have been described. Although basic research has identified many targets, most has been conducted in rodent models which may not be directly applicable to human disease and even promising agents have been disappointing in large-scale clinical trials. There are many potential explanations for this failure which is the subject of this review. Potential factors include (1) the variability inherent in the patient population, whereas animal studies usually use single sex homogeneous groups maintained on standard diets in carefully controlled environments; (2) the duration of ischemia is generally shorter in animal studies, resulting in potentially more salvageable myocardium than is often the case in patients; (3) that the animals are usually young without comorbidities, whereas the patient population is generally older and has significant comorbidities; (4) animals are not treated with medications a priori, whereas the patient population is often taking medications that may affect ischemic injury; and (5) animal studies may not involve thorough assessment of effects on organs other than the heart, whereas patients can experience adverse effects of treatment in other organs that can preclude clinical use.
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Affiliation(s)
- Richard S Vander Heide
- Department of Pathology, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA.
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T1 mapping as new diagnostic technique in a case of acute onset of biopsy-proven viral myocarditis. Clin Res Cardiol 2014; 103:405-8. [DOI: 10.1007/s00392-013-0658-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 12/18/2013] [Indexed: 10/25/2022]
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73
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Progression in attenuating myocardial reperfusion injury: An overview. Int J Cardiol 2014; 170:261-9. [DOI: 10.1016/j.ijcard.2013.11.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 09/21/2013] [Accepted: 11/02/2013] [Indexed: 12/16/2022]
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Wince WB, Suranyi P, Schoepf UJ. Contemporary cardiovascular imaging methods for the assessment of at-risk myocardium. J Am Heart Assoc 2013; 3:e000473. [PMID: 24366853 PMCID: PMC3959708 DOI: 10.1161/jaha.113.000473] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- W Benjamin Wince
- Department of Medicine, Medical University of South Carolina Heart and Vascular Center, Medical University of South Carolina, Charleston, SC
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Feng Y, Chen F, Ma Z, Dekeyzer F, Yu J, Xie Y, Cona MM, Oyen R, Ni Y. Towards stratifying ischemic components by cardiac MRI and multifunctional stainings in a rabbit model of myocardial infarction. Am J Cancer Res 2013; 4:24-35. [PMID: 24396513 PMCID: PMC3881225 DOI: 10.7150/thno.7188] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 09/10/2013] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES We sought to identify critical components of myocardial infarction (MI) including area at risk (AAR), MI-core and salvageable zone (SZ) by using cardiac magnetic resonance imaging (cMRI) and multifunctional stainings in rabbits. MATERIALS AND METHODS Fifteen rabbits received 90-min coronary artery (CA) ligation and reopening to induce reperfused MI. First-pass perfusion weighted imaging (PWI(90')) was performed immediately before CA reperfusion. Necrosis avid dye Evans blue (EB) was intravenously injected for later MI-core detection. One-day later, cMRI with T2-weighted imaging (T2WI), PWI(24h) and delayed enhancement (DE) T1WI was performed at a 3.0T clinical scanner. The heart was excised and CA was re-ligated with aorta infused by red-iodized-oil (RIO). The heart was sliced into 3-mm sections for digital radiography (DR), histology and planimetry with myocardial salvage index (MSI) and perfusion density rate (PDR) calculated. RESULTS There was no significant difference between MI-cores defined by DE-T1WI and EB-staining (31.13±8.55% vs 29.80±7.97%; p=0.74). The AAR was defined similarly by PWI90' (39.93±9.51%), RIO (38.82±14.41%) and DR (38.17±15.98%), underestimated by PWI(24h) (36.44±5.31%), but overestimated (p<0.01) by T2WI (56.93±8.87%). Corresponding MSI turned out to be 24.17±9.5% (PWI(90')), 21.97±9.41% (DR) and 22.68±9.65% (RIO), which were significantly (p<0.01) higher and lower than that with PWI(24h) (15.15±7.34%) and T2WI (45.52±7.5%) respectively. The PDR differed significantly (p<0.001) between normal myocardium (350.6±33.1%) and the AAR (31.2±15%), suggesting 11-times greater blood perfusion in normal myocardium over the AAR. CONCLUSION The introduced rabbit platform and new staining techniques together with the use of a 3.0T clinical scanner for cMRI enabled visualization of MI components and may contribute to translational cardiac imaging research for improved theranostic management of ischemic heart disease.
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Nensa F, Poeppel TD, Beiderwellen K, Schelhorn J, Mahabadi AA, Erbel R, Heusch P, Nassenstein K, Bockisch A, Forsting M, Schlosser T. Hybrid PET/MR Imaging of the Heart: Feasibility and Initial Results. Radiology 2013; 268:366-73. [DOI: 10.1148/radiol.13130231] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Marwick TH, Neubauer S, Petersen SE. Use of Cardiac Magnetic Resonance and Echocardiography in Population-Based Studies. Circ Cardiovasc Imaging 2013; 6:590-6. [DOI: 10.1161/circimaging.113.000498] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Thomas H. Marwick
- From the Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia (T.H.M.); Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, United Kingdom (S.N.); NIHR Cardiovascular Biomedical Research Unit at Barts, The London Chest Hospital, London, United Kingdom (S.E.P.); and Queen Mary, University of London, London, United Kingdom (S.E.P.)
| | - Stefan Neubauer
- From the Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia (T.H.M.); Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, United Kingdom (S.N.); NIHR Cardiovascular Biomedical Research Unit at Barts, The London Chest Hospital, London, United Kingdom (S.E.P.); and Queen Mary, University of London, London, United Kingdom (S.E.P.)
| | - Steffen E. Petersen
- From the Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia (T.H.M.); Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, United Kingdom (S.N.); NIHR Cardiovascular Biomedical Research Unit at Barts, The London Chest Hospital, London, United Kingdom (S.E.P.); and Queen Mary, University of London, London, United Kingdom (S.E.P.)
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Ruder TD, Ebert LC, Khattab AA, Rieben R, Thali MJ, Kamat P. Edema is a sign of early acute myocardial infarction on post-mortem magnetic resonance imaging. Forensic Sci Med Pathol 2013; 9:501-5. [DOI: 10.1007/s12024-013-9459-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2013] [Indexed: 03/25/2023]
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Goldfarb JW, Hasan U, Zhao W, Han J. Magnetic resonance susceptibility weighted phase imaging for the assessment of reperfusion intramyocardial hemorrhage. Magn Reson Med 2013; 71:1210-20. [DOI: 10.1002/mrm.24747] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- James W. Goldfarb
- Department of Research and Education; Saint Francis Hospital; Roslyn New York USA
- Program in Biomedical Engineering; SUNY Stony Brook; Stony Brook New York USA
| | - Usama Hasan
- Department of Research and Education; Saint Francis Hospital; Roslyn New York USA
- New York College of Osteopathic Medicine; Old Westbury New York USA
| | - Wenguo Zhao
- Department of Research and Education; Saint Francis Hospital; Roslyn New York USA
| | - Jing Han
- Department of Research and Education; Saint Francis Hospital; Roslyn New York USA
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Salvage assessment with cardiac MRI following acute myocardial infarction underestimates potential for recovery of systolic strain. Eur Radiol 2012. [PMID: 23179525 DOI: 10.1007/s00330-012-2715-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Our aim was to evaluate the relationship between the degree of salvage following acute ST elevation myocardial infarction (STEMI) and subsequent reversible contractile dysfunction using cardiac magnetic resonance (CMR) imaging. METHODS Thirty-four patients underwent CMR examination 1-7 days after primary percutaneous coronary intervention (PPCI) for acute STEMI with follow-up at 1 year. The ischaemic area-at-risk (AAR) was assessed with T2-weighted imaging and myocardial necrosis with late gadolinium enhancement. Myocardial strain was quantified with complementary spatial modulation of magnetisation (CSPAMM) tagging. RESULTS Ischaemic segments with poor (<25 %) or intermediate (26-50 %) salvage index were associated with worse Eulerian circumferential (Ecc) strain immediately post-PPCI (-9.1 % ± 0.6, P = 0.033 and -11.8 % ± 1.3, P = 0.003, respectively) than those with a high (51-100 %) salvage index (-14.4 % ± 1.3). Mean strain in ischaemic myocardium improved between baseline and follow-up (-10.1 % ± 0.5 vs. -16.2 % ± 0.5 %, P < 0.0001). Segments with poor salvage also showed an improvement in strain by 1 year (-9.1 % ± 0.6 vs. -15.3 % ± 0.6, P = 0.033) although they remained the most functionally impaired. CONCLUSIONS Partial recovery of peak systolic strain following PPCI is observed even when apparent salvage is less than 25 %. Late gadolinium enhancement (LGE) may not equate to irreversibly injured myocardium and salvage assessment performed within the first week of revascularisation may underestimate the potential for functional recovery. KEY POINTS • MRI can measure how much myocardium is damaged after a heart attack. • Heart muscle that appears initially non-viable may sometimes partially recover. • Enhancement around the edges of infarcts may resolve over time. • Evaluating new cardio-protective treatments with MRI requires appreciation of its limitations.
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