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Combined T1-mapping and tissue tracking analysis predicts severity of ischemic injury following acute STEMI-an Oxford Acute Myocardial Infarction (OxAMI) study. Int J Cardiovasc Imaging 2019; 35:1297-1308. [PMID: 30778713 PMCID: PMC6598944 DOI: 10.1007/s10554-019-01542-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 01/18/2019] [Indexed: 12/13/2022]
Abstract
Early risk stratification after ST-segment–elevation myocardial infarction (STEMI) is of major clinical importance. Strain quantifies myocardial deformation and can demonstrate abnormal global and segmental myocardial function in acute ischaemia. Native T1-mapping allows assessment of the severity of acute ischemic injury, however its clinical applicability early post MI is limited by the complex dynamic changes happening in the myocardium post MI. We aimed to explore relationship between T1-mapping and feature tracking imaging, to establish whether combined analysis of these parameters could predict recovery after STEMI. 96 STEMI patients (aged 60 ± 11) prospectively recruited in the Oxford Acute Myocardial Infarction (OxAMI) study underwent 3T-CMR scans acutely (within 53 ± 32 h from primary percutaneous coronary intervention) and at 6 months (6M). The imaging protocol included: cine, ShMOLLI T1-mapping and late gadolinium enhancement (LGE). Segments were divided in the infarct, adjacent and remote zones based on the presence of LGE. Peak circumferential (Ecc) and radial (Err) strain was assessed using cvi42 software. Acute segmental strain correlated with segmental T1-mapping values (T1 vs. Err − 0.75 ± 0.25, p < 0.01; T1 vs. Ecc 0.72 ± 0.32, p < 0.01) and with LGE segmental injury (LGE vs. Err − 0.56 ± 0.29, p < 0.01; LGE vs. Ecc 0.54 ± 0.35, p < 0.01). Moreover, acute segmental T1 and strain predicted segmental LGE transmurality on 6M scans (p < 0.001, r = 0.5). Multiple regression analysis confirmed combined analysis of global Ecc and T1-mapping was significantly better than either method alone in predicting final infarct size at 6M (r = 0.556 vs r = 0.473 for global T1 only and r = 0.476 for global Ecc only, p < 0.001). This novel CMR method combining T1-mapping and feature tracking analysis of acute CMR scans predicts LGE transmurality and infarct size at 6M following STEMI.
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Das A, Plein S, Dall’Armellina E. Cardiorresonancia para la estratificación pronóstica del infarto de miocardio. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.07.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Alkhalil M, Borlotti A, De Maria GL, Gaughran L, Langrish J, Lucking A, Ferreira V, Kharbanda RK, Banning AP, Channon KM, Dall’Armellina E, Choudhury RP. Dynamic changes in injured myocardium, very early after acute myocardial infarction, quantified using T1 mapping cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2018; 20:82. [PMID: 30567572 PMCID: PMC6300907 DOI: 10.1186/s12968-018-0506-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 11/11/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND It has recently been suggested that myocardial oedema follows a bimodal pattern early post ST-segment elevation myocardial infarction (STEMI). Yet, water content, quantified using tissue desiccation, did not return to normal values unlike oedema quantified by cardiovascular magnetic resonance (CMR) imaging. We studied the temporal changes in the extent and intensity of injured myocardium using T1-mapping technique within the first week after STEMI. METHODS A first group (n = 31) underwent 3 acute 3 T CMR scans (time-point (TP) < 3 h, 24 h and 6 days), including cine, native shortened modified look-locker inversion recovery T1 mapping, T2* mapping and late gadolinium enhancement (LGE). A second group (n = 17) had a single scan at 24 h with an additional T2-weighted sequence to assess the difference in the extent of area-at-risk (AAR) compared to T1-mapping. RESULTS The mean T1 relaxation time value within the AAR of the first group was reduced after 24 h (P < 0.001 for TP1 vs.TP2) and subsequently increased at 6 days (P = 0.041 for TP2 vs.TP3). However, the extent of AAR quantified using T1-mapping did not follow the same course, and no change was detected between TP1&TP2 (P = 1.0) but was between TP2 &TP3 (P = 0.019). In the second group, the extent of AAR was significantly larger on T1-mapping compared to T2-weighted (42 ± 15% vs. 39 ± 15%, P = 0.025). No change in LGE was detected while microvascular obstruction and intra-myocardial haemorrhage peaked at different time points within the first week of reperfusion. CONCLUSION The intensity of oedema post-STEMI followed a bimodal pattern; while the extent of AAR did not track the same course. This discrepancy has implications for use of CMR in this context and may explain the previously reported disagreement between oedema quantified by imaging and tissue desiccation.
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Affiliation(s)
- Mohammad Alkhalil
- Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Division of Cardiovascular Medicine, BHF Centre of Research Excellence, University of Oxford, Oxford, UK
| | - Alessandra Borlotti
- Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Giovanni Luigi De Maria
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, OX3 9DU UK
| | - Lisa Gaughran
- Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Jeremy Langrish
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, OX3 9DU UK
| | - Andrew Lucking
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, OX3 9DU UK
| | - Vanessa Ferreira
- Division of Cardiovascular Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford, UK
| | - Rajesh K. Kharbanda
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, OX3 9DU UK
| | - Adrian P. Banning
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, OX3 9DU UK
| | - Keith M. Channon
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, OX3 9DU UK
- Division of Cardiovascular Medicine, BHF Centre of Research Excellence, University of Oxford, Oxford, UK
| | - Erica Dall’Armellina
- Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Robin P. Choudhury
- Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, OX3 9DU UK
- Division of Cardiovascular Medicine, BHF Centre of Research Excellence, University of Oxford, Oxford, UK
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Mangion K, Carrick D, Carberry J, Mahrous A, McComb C, Oldroyd KG, Eteiba H, Lindsay M, McEntegart M, Hood S, Petrie MC, Watkins S, Davie A, Zhong X, Epstein FH, Haig CE, Berry C. Circumferential Strain Predicts Major Adverse Cardiovascular Events Following an Acute ST-Segment-Elevation Myocardial Infarction. Radiology 2018; 290:329-337. [PMID: 30457480 DOI: 10.1148/radiol.2018181253] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Purpose To investigate the prognostic value of circumferential left ventricular (LV) strain measured by using cardiac MRI for prediction of major adverse cardiac events (MACE) following an acute ST-segment-elevation myocardial infarction (STEMI). Materials and Methods Participants with acute STEMI were prospectively enrolled from May 11, 2011, to November 22, 2012. Cardiac MRI was performed at 1.5 T during the index hospitalization. Displacement encoding with stimulated echoes (DENSE) and feature tracking of cine cardiac MRI was used to assess circumferential LV strain. MACE that occurred after discharge were independently assessed by cardiologists blinded to the baseline observations. Results A total of 259 participants (mean age, 58 years ± 11 [standard deviation]; 198 men [mean age, 58 years ± 11] and 61 women [mean age, 58 years ± 12]) underwent cardiac MRI 2.2 days ± 1.9 after STEMI. Average infarct size was 18% ± 13 of LV mass and circumferential strain was -13% ± 3 (DENSE method) and -24% ± 7 (feature- tracking method). Fifty-one percent (131 of 259 participants) had presence of microvascular obstruction. During a median follow-up period of 4 years, 8% (21 of 259) experienced MACE. Area under the curve (AUC) for DENSE was different from that of feature tracking (AUC, 0.76 vs 0.62; P = .03). AUC for DENSE was similar to that of initial infarct size (P = .06) and extent of microvascular obstruction (P = .08). DENSE-derived strain provided incremental prognostic benefit over infarct size for prediction of MACE (hazard ratio, 1.3; P < .01). Conclusion Circumferential strain has independent prognostic importance in study participants with acute ST-segment-elevation myocardial infarction. Published under a CC BY 4.0 license. Online supplemental material is available for this article. See also the editorial by Kramer in this issue.
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Affiliation(s)
- Kenneth Mangion
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - David Carrick
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - Jaclyn Carberry
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - Ahmed Mahrous
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - Christie McComb
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - Keith G Oldroyd
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - Hany Eteiba
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - Mitchell Lindsay
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - Margaret McEntegart
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - Stuart Hood
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - Mark C Petrie
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - Stuart Watkins
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - Andrew Davie
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - Xiaodong Zhong
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - Frederick H Epstein
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - Caroline E Haig
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - Colin Berry
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
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Puntmann VO, Valbuena S, Hinojar R, Petersen SE, Greenwood JP, Kramer CM, Kwong RY, McCann GP, Berry C, Nagel E. Society for Cardiovascular Magnetic Resonance (SCMR) expert consensus for CMR imaging endpoints in clinical research: part I - analytical validation and clinical qualification. J Cardiovasc Magn Reson 2018; 20:67. [PMID: 30231886 PMCID: PMC6147157 DOI: 10.1186/s12968-018-0484-5] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 08/05/2018] [Indexed: 02/07/2023] Open
Abstract
Cardiovascular disease remains a leading cause of morbidity and mortality globally. Changing natural history of the disease due to improved care of acute conditions and ageing population necessitates new strategies to tackle conditions which have more chronic and indolent course. These include an increased deployment of safe screening methods, life-long surveillance, and monitoring of both disease activity and tailored-treatment, by way of increasingly personalized medical care. Cardiovascular magnetic resonance (CMR) is a non-invasive, ionising radiation-free method, which can support a significant number of clinically relevant measurements and offers new opportunities to advance the state of art of diagnosis, prognosis and treatment. The objective of the SCMR Clinical Trial Taskforce was to summarizes the evidence to emphasize where currently CMR-guided clinical care can indeed translate into meaningful use and efficient deployment of resources results in meaningful and efficient use. The objective of the present initiative was to provide an appraisal of evidence on analytical validation, including the accuracy and precision, and clinical qualification of parameters in disease context, clarifying the strengths and weaknesses of the state of art, as well as the gaps in the current evidence This paper is complementary to the existing position papers on standardized acquisition and post-processing ensuring robustness and transferability for widespread use. Themed imaging-endpoint guidance on trial design to support drug-discovery or change in clinical practice (part II), will be presented in a follow-up paper in due course. As CMR continues to undergo rapid development, regular updates of the present recommendations are foreseen.
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Affiliation(s)
- Valentina O Puntmann
- Institute of Experimental and Translational Cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt, Germany
- Department of Cardiology, Goethe University Hospital Frankfurt, Frankfurt, Germany
| | - Silvia Valbuena
- Department of Cardiology, University Hospital La Paz, Madrid, Germany
| | - Rocio Hinojar
- Department of Cardiology, University Hospital Ramón y Cajal, Madrid, Spain
| | - Steffen E Petersen
- William Harvey Research Institute, Queen Mary University of London, Barts and the London NIHR Biomedical Research Centre at Barts, London, UK
| | - John P Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Christopher M Kramer
- Department of Medicine (Cardiology) and Radiology, Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Raymond Y Kwong
- Cardiovascular Division, Department of Medicine, Brigham and Womens' Hospital, Boston, Massachusetts, USA
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- the NIHR Leicester Cardiovascular Biomedical Centre, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | - Eike Nagel
- Institute of Experimental and Translational Cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt, Germany.
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56
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Das A, Plein S, Dall'Armellina E. Role of CMR in Prognostic Stratification in Myocardial Infarction. ACTA ACUST UNITED AC 2018; 72:115-119. [PMID: 30224251 DOI: 10.1016/j.rec.2018.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 07/31/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Arka Das
- Leeds Institute of Cardiovascular and Metabolic Medicine, Department of Biomedical Imaging Science, University of Leeds, Leeds, United Kingdom
| | - Sven Plein
- Leeds Institute of Cardiovascular and Metabolic Medicine, Department of Biomedical Imaging Science, University of Leeds, Leeds, United Kingdom
| | - Erica Dall'Armellina
- Leeds Institute of Cardiovascular and Metabolic Medicine, Department of Biomedical Imaging Science, University of Leeds, Leeds, United Kingdom.
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57
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Noninvasive Tissue Characterization of Post-Infarction Myocardium. JACC Cardiovasc Imaging 2018; 11:1257-1259. [DOI: 10.1016/j.jcmg.2017.11.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 11/13/2017] [Accepted: 11/16/2017] [Indexed: 11/17/2022]
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58
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Reinstadler SJ, Stiermaier T, Reindl M, Feistritzer HJ, Fuernau G, Eitel C, Desch S, Klug G, Thiele H, Metzler B, Eitel I. Intramyocardial haemorrhage and prognosis after ST-elevation myocardial infarction. Eur Heart J Cardiovasc Imaging 2018; 20:138-146. [DOI: 10.1093/ehjci/jey101] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/19/2018] [Indexed: 12/12/2022] Open
Affiliation(s)
- Sebastian J Reinstadler
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, University of Lübeck, Ratzeburger Allee 160, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, Lübeck, Germany
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - Thomas Stiermaier
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, University of Lübeck, Ratzeburger Allee 160, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, Lübeck, Germany
| | - Martin Reindl
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - Hans-Josef Feistritzer
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - Georg Fuernau
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, University of Lübeck, Ratzeburger Allee 160, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, Lübeck, Germany
| | - Charlotte Eitel
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, University of Lübeck, Ratzeburger Allee 160, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, Lübeck, Germany
| | - Steffen Desch
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, University of Lübeck, Ratzeburger Allee 160, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, Lübeck, Germany
| | - Gert Klug
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - Holger Thiele
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, University of Lübeck, Ratzeburger Allee 160, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, Lübeck, Germany
| | - Bernhard Metzler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - Ingo Eitel
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, University of Lübeck, Ratzeburger Allee 160, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, Lübeck, Germany
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Masci PG, Pavon AG, Muller O, Iglesias JF, Vincenti G, Monney P, Harbaoui B, Eeckhout E, Schwitter J. Relationship between CMR-derived parameters of ischemia/reperfusion injury and the timing of CMR after reperfused ST-segment elevation myocardial infarction. J Cardiovasc Magn Reson 2018; 20:50. [PMID: 30037343 PMCID: PMC6055335 DOI: 10.1186/s12968-018-0474-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 06/26/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND To investigate the influence of cardiovascular magnetic resonance (CMR) timing after reperfusion on CMR-derived parameters of ischemia/reperfusion (I/R) injury in patients with ST-segment elevation myocardial infarction (STEMI). METHODS The study included 163 reperfused STEMI patients undergoing CMR during the index hospitalization. Patients were divided according to the time between revascularization and CMR (Trevasc-CMR: Tertile-1 ≤ 43; 43 < Tertile-2 ≤ 93; Tertile-3 > 93 h). T2-mapping derived area-at-risk (AAR) and intramyocardial-hemorrhage (IMH), and late gadolinium enhancement (LGE)-derived infarct size (IS) and microvascular obstruction (MVO) were quantified. T1-mapping was performed before and > 15 min after Gd-based contrast-agent administration yielding extracellular volume (ECV) of infarct. RESULTS Main factors influencing I/R injury were homogenously balanced across Trevasc-CMR tertiles. T2 values of infarct and remote regions increased with increasing Trevasc-CMR tertiles (infarct: 60.0 ± 4.9 vs 63.5 ± 5.6 vs 64.8 ± 7.5 ms; P < 0.001; remote: 44.3 ± 2.8 vs 46.1 ± 2.8 vs ± 46.1 ± 3.0; P = 0.001). However, T2 value of infarct largely and significantly exceeded that of remote myocardium in each tertile yielding comparable T2-mapping-derived AAR extent throughout Trevasc-CMR tertiles (17 ± 9% vs 19 ± 9% vs 18 ± 8% of LV, respectively, P = 0.385). Similarly, T2-mapping-based IMH detection and quantification were independent of Trevasc-CMR. LGE-derived IS and MVO were not influenced by Trevasc-CMR (IS: 12 ± 9% vs 12 ± 9% vs 14 ± 9% of LV, respectively, P = 0.646). In 68 patients without MVO, T1-mapping based ECV of infarct region was comparable across Trevasc-CMR tertiles (P = 0.470). CONCLUSION In STEMI patients, T2 values of infarct and remote myocardium increase with increasing CMR time after revascularization. However, these changes do not give rise to substantial variation of T2-mapping-derived AAR size nor of other CMR-based parameters of I/R. TRIAL REGISTRATION ISRCTN03522116 . Registered 30.4.2018 (retrospectively registered).
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Affiliation(s)
- Pier-Giorgio Masci
- Centre of Cardiac Magnetic Resonance, University Hospital Lausanne-CHUV, Lausanne, Switzerland
- Cardiology Division, Heart & Vessels Department, Lausanne University Hospital-CHUV, BH-09-792 Rue de Bugnon 46, CH-1011 Lausanne, Vaud Switzerland
| | - Anna Giulia Pavon
- Centre of Cardiac Magnetic Resonance, University Hospital Lausanne-CHUV, Lausanne, Switzerland
- Cardio-Thoracic-Vascular Department, San Raffaele’s Scientific Institute, Milan, Italy
| | - Olivier Muller
- Cardiology Division, Heart & Vessels Department, Lausanne University Hospital-CHUV, BH-09-792 Rue de Bugnon 46, CH-1011 Lausanne, Vaud Switzerland
| | - Juan-Fernando Iglesias
- Cardiology Division, Heart & Vessels Department, Lausanne University Hospital-CHUV, BH-09-792 Rue de Bugnon 46, CH-1011 Lausanne, Vaud Switzerland
| | - Gabriella Vincenti
- Centre of Cardiac Magnetic Resonance, University Hospital Lausanne-CHUV, Lausanne, Switzerland
- Cardiology Division, Heart & Vessels Department, Lausanne University Hospital-CHUV, BH-09-792 Rue de Bugnon 46, CH-1011 Lausanne, Vaud Switzerland
| | - Pierre Monney
- Centre of Cardiac Magnetic Resonance, University Hospital Lausanne-CHUV, Lausanne, Switzerland
- Cardiology Division, Heart & Vessels Department, Lausanne University Hospital-CHUV, BH-09-792 Rue de Bugnon 46, CH-1011 Lausanne, Vaud Switzerland
| | - Brahim Harbaoui
- Cardiology Division, Heart & Vessels Department, Lausanne University Hospital-CHUV, BH-09-792 Rue de Bugnon 46, CH-1011 Lausanne, Vaud Switzerland
| | - Eric Eeckhout
- Cardiology Division, Heart & Vessels Department, Lausanne University Hospital-CHUV, BH-09-792 Rue de Bugnon 46, CH-1011 Lausanne, Vaud Switzerland
| | - Juerg Schwitter
- Centre of Cardiac Magnetic Resonance, University Hospital Lausanne-CHUV, Lausanne, Switzerland
- Cardiology Division, Heart & Vessels Department, Lausanne University Hospital-CHUV, BH-09-792 Rue de Bugnon 46, CH-1011 Lausanne, Vaud Switzerland
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Chen BH, Shi RY, An DA, Wu R, Wu CW, Hu J, Manly A, Kaddurah H, He J, Pu J, Xu JR, Wu LM. BOLD cardiac MRI for differentiating reversible and irreversible myocardial damage in ST segment elevation myocardial infarction. Eur Radiol 2018; 29:951-962. [PMID: 29987418 DOI: 10.1007/s00330-018-5612-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 06/07/2018] [Accepted: 06/15/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVES BOLD imaging is a quantitative MRI technique allowing the evaluation of the balance between supply/demand in myocardial oxygenation and myocardial haemorrhage. We sought to investigate the ability of BOLD imaging to differentiate reversible from irreversible myocardial injury as well as the chronological progression of myocardial oxygenation after reperfusion in patients with ST segment elevation myocardial infarction (STEMI). METHODS Twenty-two patients (age, 60 ± 11 years; 77.3% male) with STEMI underwent cardiac MRIs on four occasions: on days 1, 3, 7 and 30 after reperfusion. BOLD MRI was obtained with a multi-echo turbo field echo (TFE) sequence on a 3-T scanner to assess myocardial oxygenation in MI. RESULTS T2* value in MI with intramyocardial haemorrhage (IMH) was the lowest (9.77 ± 3.29 ms), while that of the salvaged zone was the highest (33.97 ± 3.42 ms). T2* values in salvaged myocardium demonstrated a unimodal temporal pattern from days 1 (37.91 ± 2.23 ms) to 30 (30.68 ± 1.59 ms). T2* values in the MI regions were significantly lower than those in remote myocardium, although the trends in both were constant overall. There was a slightly positive correlation between T2* in MI regions and EF (Rho = 0.27, p < 0.05) or SV (Rho = 0.22, p = 0.04) and a slightly negative correlation between T2* in salvaged myocardium and LVEDV (Rho = - 0.23, p < 0.05). CONCLUSIONS BOLD MRI performed in post-STEMI patients allows accurate evaluation of myocardial damage severity and could differentiate reversible from irreversible myocardial injury. The increased T2* values may imply the pathophysiological mechanism of salvaged myocardium. BOLD MRI could represent a more accurate alternative to the other currently available options. KEY POINTS • Myocardial oxygenation and haemorrhage after myocardial infarction affect BOLD MRI values • BOLD MRI could be used to differentiate irreversible from reversible myocardial damage • Changed oxygenation implies the pathophysiological mechanism of salvaged myocardium.
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Affiliation(s)
- Bing-Hua Chen
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, People's Republic of China
| | - Ruo-Yang Shi
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, People's Republic of China
| | - Dong-Aolei An
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, People's Republic of China
| | - Rui Wu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, People's Republic of China
| | - Chong-Wen Wu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, People's Republic of China
| | - Jiani Hu
- Department of Radiology, Wayne State University, Detroit, MI, 48201, USA
| | - Amanda Manly
- Department of Radiology, Wayne State University, Detroit, MI, 48201, USA
| | - Hisham Kaddurah
- Department of Radiology, Wayne State University, Detroit, MI, 48201, USA
| | - Jie He
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, People's Republic of China
| | - Jun Pu
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, People's Republic of China
| | - Jian-Rong Xu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, People's Republic of China.
| | - Lian-Ming Wu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, People's Republic of China.
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Symons R, Claus P, Marchi A, Dresselaers T, Bogaert J. Quantitative and qualitative assessment of acute myocardial injury by CMR at multiple time points after acute myocardial infarction. Int J Cardiol 2018; 259:43-46. [PMID: 29506936 DOI: 10.1016/j.ijcard.2018.02.093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 01/11/2018] [Accepted: 02/22/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Recent experimental studies have shown a dynamic time course of myocardial edema with an initial wave of edematous reaction within hours after reperfusion which almost resolved at 24 h. However, this dynamic pattern appears to be absent in clinical cohort studies. Thus far, no studies have combined a quantitative and qualitative assessment of acute myocardial injury in a large clinical cohort to explain these divergent findings. METHODS A cohort of 225 patients (59 ± 11 years, 83% men) with successfully reperfused STEMI within 12 h of symptom onset were included. Quantitative measurements of myocardial damage such as T1 mapping and T2 triple short-tau inversion recovery (STIR), contrast-to-noise ratio (CNR) and their impact on area-at-risk (AAR), infarct size (IS), and myocardial salvage index (MSI) were assessed at different time points. One-way analysis of variance (ANOVA) and linear regression analysis was used to compare myocardial damage at the different time points. RESULTS A small fraction of patients underwent CMR within 24 h of reperfusion (17/225, 7.6%). No significant variations in AAR, IS, MSI, T2 STIR CNR, or native T1 maps were observed between the different time points after reperfusion. Time of CMR was not a significant predictor of AAR (P = 0.90), IS (P = 0.27), MSI (P = 0.23) or T2 STIR CNR (P = 0.23). CONCLUSIONS The majority of CMR exams in STEMI patients are performed outside the dynamic time window of early post-MI edema. The stable pattern of markers of acute myocardial damage at different time points suggests these markers are reliable for the prognostication of patients after STEMI.
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Affiliation(s)
- Rolf Symons
- Department of Imaging and Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Piet Claus
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Alberto Marchi
- Medical Pathology Department, Careggi University Hospital, Florence, Italy
| | - Tom Dresselaers
- Department of Imaging and Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Jan Bogaert
- Department of Imaging and Pathology, University Hospitals Leuven, Leuven, Belgium.
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Bulluck H, Hausenloy DJ. Letter by Bulluck and Hausenloy Regarding Article, "Dynamic Edematous Response of the Human Heart to Myocardial Infarction: Implications for Assessing Myocardial Area at Risk and Salvage". Circulation 2018; 137:1748-1749. [PMID: 29661955 DOI: 10.1161/circulationaha.117.030974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Heerajnarain Bulluck
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., D.J.H.).,The National Institute of Health Research University College London Hospitals Biomedical Research Centre, UK (D.J.H.).,Barts Heart Centre, St Bartholomew's Hospital, London, UK (D.J.H.).,National Heart Research Institute Singapore, National Heart Centre Singapore (D.J.H.).,Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (D.J.H.).,Yong Loo Lin School of Medicine, National University Singapore (D.J.H.)
| | - Derek J Hausenloy
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., D.J.H.).,Royal Papworth Hospital, Cambridge, UK (H.B.)
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Stiermaier T, Bogaert J, Eitel I. Letter by Stiermaier et al Regarding Article, "Dynamic Edematous Response of the Human Heart to Myocardial Infarction: Implications for Assessing Myocardial Area at Risk and Salvage". Circulation 2018; 137:1752-1753. [PMID: 29661957 DOI: 10.1161/circulationaha.117.032452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Thomas Stiermaier
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Germany (T.S., I.E.).,German Center for Cardiovascular Research, partner site Hamburg/Kiel/Lübeck, Germany (T.S., I.E.)
| | - Jan Bogaert
- Department of Imaging and Pathology, Katholieke Universiteit (Leuven)-University of Leuven, Belgium (J.B.)
| | - Ingo Eitel
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Germany (T.S., I.E.).,German Center for Cardiovascular Research, partner site Hamburg/Kiel/Lübeck, Germany (T.S., I.E.)
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Myocardial Salvage Imaging: Where Are We and Where Are We Heading? A Cardiac Magnetic Resonance Perspective. CURRENT CARDIOVASCULAR IMAGING REPORTS 2018. [DOI: 10.1007/s12410-018-9448-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Du X. Post-infarct cardiac injury, protection and repair: roles of non-cardiomyocyte multicellular and acellular components. SCIENCE CHINA-LIFE SCIENCES 2018; 61:266-276. [DOI: 10.1007/s11427-017-9223-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 10/23/2017] [Indexed: 02/06/2023]
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Affiliation(s)
- Annette Marie Maznyczka
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Peter McCartney
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
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Patel H, Mazur W, Williams KA, Kalra DK. Myocardial viability–State of the art: Is it still relevant and how to best assess it with imaging? Trends Cardiovasc Med 2018; 28:24-37. [DOI: 10.1016/j.tcm.2017.07.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 06/30/2017] [Accepted: 07/04/2017] [Indexed: 10/19/2022]
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Carberry J, Carrick D, Haig C, Ahmed N, Mordi I, McEntegart M, Petrie MC, Eteiba H, Hood S, Watkins S, Lindsay M, Davie A, Mahrous A, Ford I, Sattar N, Welsh P, Radjenovic A, Oldroyd KG, Berry C. Persistence of Infarct Zone T2 Hyperintensity at 6 Months After Acute ST-Segment-Elevation Myocardial Infarction: Incidence, Pathophysiology, and Prognostic Implications. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.117.006586. [PMID: 29242240 PMCID: PMC5753833 DOI: 10.1161/circimaging.117.006586] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 11/01/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND The incidence and clinical significance of persistent T2 hyperintensity after acute ST-segment-elevation myocardial infarction (STEMI) is uncertain. METHODS AND RESULTS Patients who sustained an acute STEMI were enrolled in a cohort study (BHF MR-MI: NCT02072850). Two hundred eighty-three STEMI patients (mean age, 59±12 years; 75% male) had cardiac magnetic resonance with T2 mapping performed at 2 days and 6 months post-STEMI. Persisting T2 hyperintensity was defined as infarct T2 >2 SDs from remote T2 at 6 months. Infarct zone T2 was higher than remote zone T2 at 2 days (66.3±6.1 versus 49.7±2.1 ms; P<0.001) and 6 months (56.8±4.5 versus 49.7±2.3 ms; P<0.001). Remote zone T2 did not change over time (mean change, 0.0±2.7 ms; P=0.837), whereas infarct zone T2 decreased (-9.5±6.4 ms; P<0.001). At 6 months, T2 hyperintensity persisted in 189 (67%) patients, who were more likely to have Thrombus in Myocardial Infarction flow 0 or 1 in the culprit artery (P=0.020), incomplete ST-segment resolution (P=0.037), and higher troponin (P=0.024). Persistent T2 hyperintensity was associated with NT-proBNP (N-terminal pro-B-type natriuretic peptide) concentration (0.57 on a log scale [0.42-0.72]; P=0.004) and the likelihood of adverse left ventricular remodeling (>20% change in left ventricular end-diastolic volume; 21.91 [2.75-174.29]; P=0.004). Persistent T2 hyperintensity was associated with all-cause death and heart failure, but the result was not significant (P=0.051). ΔT2 was associated with all-cause death and heart failure (P=0.004) and major adverse cardiac events (P=0.013). CONCLUSIONS Persistent T2 hyperintensity occurs in two thirds of STEMI patients. Persistent T2 hyperintensity was associated with the initial STEMI severity, adverse remodeling, and long-term health outcome. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT02072850.
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Affiliation(s)
- Jaclyn Carberry
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (J.C., D.C., N.A., I.M., M.M., M.C.P., H.E., S.H., S.W., M.L., A.D., A.M., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Scotland; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank (D.C., S.W., C.B.)
| | - David Carrick
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (J.C., D.C., N.A., I.M., M.M., M.C.P., H.E., S.H., S.W., M.L., A.D., A.M., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Scotland; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank (D.C., S.W., C.B.)
| | - Caroline Haig
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (J.C., D.C., N.A., I.M., M.M., M.C.P., H.E., S.H., S.W., M.L., A.D., A.M., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Scotland; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank (D.C., S.W., C.B.)
| | - Nadeem Ahmed
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (J.C., D.C., N.A., I.M., M.M., M.C.P., H.E., S.H., S.W., M.L., A.D., A.M., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Scotland; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank (D.C., S.W., C.B.)
| | - Ify Mordi
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (J.C., D.C., N.A., I.M., M.M., M.C.P., H.E., S.H., S.W., M.L., A.D., A.M., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Scotland; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank (D.C., S.W., C.B.)
| | - Margaret McEntegart
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (J.C., D.C., N.A., I.M., M.M., M.C.P., H.E., S.H., S.W., M.L., A.D., A.M., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Scotland; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank (D.C., S.W., C.B.)
| | - Mark C Petrie
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (J.C., D.C., N.A., I.M., M.M., M.C.P., H.E., S.H., S.W., M.L., A.D., A.M., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Scotland; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank (D.C., S.W., C.B.)
| | - Hany Eteiba
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (J.C., D.C., N.A., I.M., M.M., M.C.P., H.E., S.H., S.W., M.L., A.D., A.M., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Scotland; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank (D.C., S.W., C.B.)
| | - Stuart Hood
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (J.C., D.C., N.A., I.M., M.M., M.C.P., H.E., S.H., S.W., M.L., A.D., A.M., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Scotland; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank (D.C., S.W., C.B.)
| | - Stuart Watkins
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (J.C., D.C., N.A., I.M., M.M., M.C.P., H.E., S.H., S.W., M.L., A.D., A.M., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Scotland; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank (D.C., S.W., C.B.)
| | - Mitchell Lindsay
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (J.C., D.C., N.A., I.M., M.M., M.C.P., H.E., S.H., S.W., M.L., A.D., A.M., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Scotland; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank (D.C., S.W., C.B.)
| | - Andrew Davie
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (J.C., D.C., N.A., I.M., M.M., M.C.P., H.E., S.H., S.W., M.L., A.D., A.M., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Scotland; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank (D.C., S.W., C.B.)
| | - Ahmed Mahrous
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (J.C., D.C., N.A., I.M., M.M., M.C.P., H.E., S.H., S.W., M.L., A.D., A.M., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Scotland; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank (D.C., S.W., C.B.)
| | - Ian Ford
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (J.C., D.C., N.A., I.M., M.M., M.C.P., H.E., S.H., S.W., M.L., A.D., A.M., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Scotland; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank (D.C., S.W., C.B.)
| | - Naveed Sattar
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (J.C., D.C., N.A., I.M., M.M., M.C.P., H.E., S.H., S.W., M.L., A.D., A.M., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Scotland; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank (D.C., S.W., C.B.)
| | - Paul Welsh
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (J.C., D.C., N.A., I.M., M.M., M.C.P., H.E., S.H., S.W., M.L., A.D., A.M., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Scotland; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank (D.C., S.W., C.B.)
| | - Aleksandra Radjenovic
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (J.C., D.C., N.A., I.M., M.M., M.C.P., H.E., S.H., S.W., M.L., A.D., A.M., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Scotland; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank (D.C., S.W., C.B.)
| | - Keith G Oldroyd
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (J.C., D.C., N.A., I.M., M.M., M.C.P., H.E., S.H., S.W., M.L., A.D., A.M., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Scotland; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank (D.C., S.W., C.B.)
| | - Colin Berry
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (J.C., D.C., N.A., I.M., M.M., M.C.P., H.E., S.H., S.W., M.L., A.D., A.M., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Scotland; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank (D.C., S.W., C.B.).
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Carberry J, Carrick D, Haig C, Ahmed N, Mordi I, McEntegart M, Petrie MC, Eteiba H, Hood S, Watkins S, Lindsay M, Davie A, Mahrous A, Ford I, Sattar N, Welsh P, Radjenovic A, Oldroyd KG, Berry C. Persistent Iron Within the Infarct Core After ST-Segment Elevation Myocardial Infarction: Implications for Left Ventricular Remodeling and Health Outcomes. JACC Cardiovasc Imaging 2017; 11:1248-1256. [PMID: 29153575 PMCID: PMC6130225 DOI: 10.1016/j.jcmg.2017.08.027] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/21/2017] [Accepted: 08/30/2017] [Indexed: 12/21/2022]
Abstract
Objectives This study sought to determine the incidence and prognostic significance of persistent iron in patients post–ST-segment elevation myocardial infarction (STEMI). Background The clinical significance of persistent iron within the infarct core after STEMI complicated by acute myocardial hemorrhage is poorly understood. Methods Patients who sustained an acute STEMI were enrolled in a cohort study (BHF MR-MI [Detection and Significance of Heart Injury in ST Elevation Myocardial Infarction]). Cardiac magnetic resonance imaging including T2* (observed time constant for the decay of transverse magnetization seen with gradient-echo sequences) mapping was performed at 2 days and 6 months post-STEMI. Myocardial hemorrhage or iron was defined as a hypointense infarct core with T2* signal <20 ms. Results A total of 203 patients (age 57 ± 11 years, n = 158 [78%] male) had evaluable T2* maps at 2 days and 6 months post-STEMI; 74 (36%) patients had myocardial hemorrhage at baseline, and 44 (59%) of these patients had persistent iron at 6 months. Clinical associates of persistent iron included heart rate (p = 0.009), the absence of a history of hypertension (p = 0.017), and infarct size (p = 0.028). The presence of persistent iron was associated with worsening left ventricular (LV) end-diastolic volume (regression coefficient: 21.10; 95% confidence interval [CI]: 10.92 to 31.27; p < 0.001) and worsening LV ejection fraction (regression coefficient: −6.47; 95% CI: −9.22 to −3.72; p < 0.001). Persistent iron was associated with the subsequent occurrence of all-cause death or heart failure (hazard ratio: 3.91; 95% CI: 1.37 to 11.14; p = 0.011) and major adverse cardiac events (hazard ratio: 3.24; 95% CI: 1.09 to 9.64; p = 0.035) (median follow-up duration 1,457 days [range 233 to 1,734 days]). Conclusions Persistent iron at 6 months post-STEMI is associated with worse LV and longer-term health outcomes. (Detection and Significance of Heart Injury in ST Elevation Myocardial Infarction [BHF MR-MI]; NCT02072850)
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Affiliation(s)
- Jaclyn Carberry
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - David Carrick
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland
| | - Caroline Haig
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland
| | - Nadeem Ahmed
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Ify Mordi
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Margaret McEntegart
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Mark C Petrie
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Hany Eteiba
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Stuart Hood
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Stuart Watkins
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland
| | - Mitchell Lindsay
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Andrew Davie
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Ahmed Mahrous
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland
| | - Naveed Sattar
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Paul Welsh
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Aleksandra Radjenovic
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Keith G Oldroyd
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland.
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Mangion K, Gao H, Husmeier D, Luo X, Berry C. Advances in computational modelling for personalised medicine after myocardial infarction. Heart 2017; 104:550-557. [PMID: 29127185 DOI: 10.1136/heartjnl-2017-311449] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 10/24/2017] [Accepted: 10/25/2017] [Indexed: 11/04/2022] Open
Abstract
Myocardial infarction (MI) is a leading cause of premature morbidity and mortality worldwide. Determining which patients will experience heart failure and sudden cardiac death after an acute MI is notoriously difficult for clinicians. The extent of heart damage after an acute MI is informed by cardiac imaging, typically using echocardiography or sometimes, cardiac magnetic resonance (CMR). These scans provide complex data sets that are only partially exploited by clinicians in daily practice, implying potential for improved risk assessment. Computational modelling of left ventricular (LV) function can bridge the gap towards personalised medicine using cardiac imaging in patients with post-MI. Several novel biomechanical parameters have theoretical prognostic value and may be useful to reflect the biomechanical effects of novel preventive therapy for adverse remodelling post-MI. These parameters include myocardial contractility (regional and global), stiffness and stress. Further, the parameters can be delineated spatially to correspond with infarct pathology and the remote zone. While these parameters hold promise, there are challenges for translating MI modelling into clinical practice, including model uncertainty, validation and verification, as well as time-efficient processing. More research is needed to (1) simplify imaging with CMR in patients with post-MI, while preserving diagnostic accuracy and patient tolerance (2) to assess and validate novel biomechanical parameters against established prognostic biomarkers, such as LV ejection fraction and infarct size. Accessible software packages with minimal user interaction are also needed. Translating benefits to patients will be achieved through a multidisciplinary approach including clinicians, mathematicians, statisticians and industry partners.
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Affiliation(s)
- Kenneth Mangion
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | - Hao Gao
- Department of Mathematics and Statistics, University of Glasgow, Glasgow, UK
| | - Dirk Husmeier
- Department of Mathematics and Statistics, University of Glasgow, Glasgow, UK
| | - Xiaoyu Luo
- Department of Mathematics and Statistics, University of Glasgow, Glasgow, UK
| | - Colin Berry
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
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Redefining viability by cardiovascular magnetic resonance in acute ST-segment elevation myocardial infarction. Sci Rep 2017; 7:14676. [PMID: 29116176 PMCID: PMC5676975 DOI: 10.1038/s41598-017-15353-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 10/24/2017] [Indexed: 01/05/2023] Open
Abstract
In chronic myocardial infarction (MI), segments with a transmural extent of infarct (TEI) of ≤50% are defined as being viable. However, in the acute phase of an ST-segment elevation myocardial infarction (STEMI), late gadolinium enhancement (LGE) has been demonstrated to overestimate MI size and TEI. We aimed to identify the optimal cut-off of TEI by cardiovascular magnetic resonance (CMR) for defining viability during the acute phase of an MI, using ≤50% TEI at follow-up as the reference standard. 40 STEMI patients reperfused by primary percutaneous coronary intervention (PPCI) underwent a CMR at 4 ± 2 days and 5 ± 2 months. The large majority of segments with 1–25%TEI and 26–50%TEI that were viable acutely were also viable at follow-up (59/59, 100% and 75/82, 96% viable respectively). 56/84(67%) segments with 51–75%TEI but only 4/63(6%) segments with 76–100%TEI were reclassified as viable at follow-up. TEI on the acute CMR scan had an area-under-the-curve of 0.87 (95% confidence interval of 0.82 to 0.91) and ≤75%TEI had a sensitivity of 98% but a specificity of 66% to predict viability at follow-up. Therefore, the optimal cut-off by CMR during the acute phase of an MI to predict viability was ≤75% TEI and this would have important implications for patients undergoing viability testing prior to revascularization during the acute phase.
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Bulluck H, Hammond-Haley M, Weinmann S, Martinez-Macias R, Hausenloy DJ. Myocardial Infarct Size by CMR in Clinical Cardioprotection Studies: Insights From Randomized Controlled Trials. JACC Cardiovasc Imaging 2017; 10:230-240. [PMID: 28279370 PMCID: PMC5348096 DOI: 10.1016/j.jcmg.2017.01.008] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/23/2017] [Accepted: 01/26/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The aim of this study was to review randomized controlled trials (RCTs) using cardiac magnetic resonance (CMR) to assess myocardial infarct (MI) size in reperfused patients with ST-segment elevation myocardial infarction (STEMI). BACKGROUND There is limited guidance on the use of CMR in clinical cardioprotection RCTs in patients with STEMI treated by primary percutaneous coronary intervention. METHODS All RCTs in which CMR was used to quantify MI size in patients with STEMI treated with primary percutaneous coronary intervention were identified and reviewed. RESULTS Sixty-two RCTs (10,570 patients, January 2006 to November 2016) were included. One-third did not report CMR vendor or scanner strength, the contrast agent and dose used, and the MI size quantification technique. Gadopentetate dimeglumine was most commonly used, followed by gadoterate meglumine and gadobutrol at 0.20 mmol/kg each, with late gadolinium enhancement acquired at 10 min; in most RCTs, MI size was quantified manually, followed by the 5 standard deviation threshold; dropout rates were 9% for acute CMR only and 16% for paired acute and follow-up scans. Weighted mean acute and chronic MI sizes (≤12 h, initial TIMI [Thrombolysis in Myocardial Infarction] flow grade 0 to 3) from the control arms were 21 ± 14% and 15 ± 11% of the left ventricle, respectively, and could be used for future sample-size calculations. Pre-selecting patients most likely to benefit from the cardioprotective therapy (≤6 h, initial TIMI flow grade 0 or 1) reduced sample size by one-third. Other suggested recommendations for standardizing CMR in future RCTs included gadobutrol at 0.15 mmol/kg with late gadolinium enhancement at 15 min, manual or 6-SD threshold for MI quantification, performing acute CMR at 3 to 5 days and follow-up CMR at 6 months, and adequate reporting of the acquisition and analysis of CMR. CONCLUSIONS There is significant heterogeneity in RCT design using CMR in patients with STEMI. The authors provide recommendations for standardizing the assessment of MI size using CMR in future clinical cardioprotection RCTs.
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Affiliation(s)
- Heerajnarain Bulluck
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom; The National Institute of Health Research University College London Hospitals Biomedical Research Center, London, United Kingdom; National Heart Research Institute Singapore, National Heart Center Singapore, Singapore, Singapore
| | - Matthew Hammond-Haley
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom
| | - Shane Weinmann
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom
| | - Roberto Martinez-Macias
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom
| | - Derek J Hausenloy
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom; The National Institute of Health Research University College London Hospitals Biomedical Research Center, London, United Kingdom; National Heart Research Institute Singapore, National Heart Center Singapore, Singapore, Singapore; Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore, Singapore.
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Effect of Intracoronary and Intravenous Melatonin on Myocardial Salvage Index in Patients with ST-Elevation Myocardial Infarction: a Randomized Placebo Controlled Trial. J Cardiovasc Transl Res 2017; 10:470-479. [PMID: 29027116 DOI: 10.1007/s12265-017-9768-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 09/27/2017] [Indexed: 01/23/2023]
Abstract
Melatonin has attenuated myocardial ischemia reperfusion injury in experimental studies. We hypothesized that the administration of melatonin during acute myocardial reperfusion improves myocardial salvage index in patients with ST-elevation myocardial infarction. Patients (n = 48) were randomized in a 1:1 ratio to intracoronary and intravenous melatonin (total 50 mg) or placebo. The myocardial salvage index assessed by cardiac magnetic resonance imaging at day 4 (± 1 day) after primary percutaneous coronary intervention was similar in the melatonin group (n = 22) at 55.3% (95% CI 47.0-63.6) and the placebo group (n = 19) at 61.5% (95% CI 57.5-65.5), p = 0.21. The levels of high-sensitive troponin T, creatinine kinase myocardial band, and oxidative biomarkers (advanced oxidation protein products, malondialdehyde, myeloperoxidase) were similar in the groups. The frequency of clinical events at 90 days did not differ between the groups. In conclusion, melatonin did not improve the myocardial salvage index after primary percutaneous coronary intervention in patients with ST elevation myocardial infarction compared with placebo.
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Granger DN, Kvietys PR. Reperfusion therapy-What's with the obstructed, leaky and broken capillaries? ACTA ACUST UNITED AC 2017; 24:213-228. [PMID: 29102280 DOI: 10.1016/j.pathophys.2017.09.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Microvascular dysfunction is well established as an early and rate-determining factor in the injury response of tissues to ischemia and reperfusion (I/R). Severe endothelial cell dysfunction, which can develop without obvious morphological cell injury, is a major underlying cause of the microvascular abnormalities that accompany I/R. While I/R-induced microvascular dysfunction is manifested in different ways, two responses that have received much attention in both the experimental and clinical setting are impaired capillary perfusion (no-reflow) and endothelial barrier failure with a transition to hemorrhage. These responses are emerging as potentially important determinants of the severity of the tissue injury response, and there is growing clinical evidence that they are predictive of clinical outcome following reperfusion therapy. This review provides a summary of animal studies that have focused on the mechanisms that may underlie the genesis of no-reflow and hemorrhage following reperfusion of ischemic tissues, and addresses the clinical evidence that implicates these vascular events in the responses of the ischemic brain (stroke) and heart (myocardial infarction) to reperfusion therapy. Inasmuch as reactive oxygen species (ROS) and matrix metalloproteinases (MMP) are frequently invoked as triggers of the microvascular dysfunction elicited by I/R, the potential roles and sources of these mediators are also discussed. The available evidence in the literature justifies the increased interest in the development of no-reflow and hemorrhage in heart and brain following reperfusion therapy, and suggests that these vascular events may be predictive of poor clinical outcome and warrant the development of targeted treatment strategies.
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Affiliation(s)
- D Neil Granger
- Department of Molecular & Cellular Physiology, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA 71130-3932, United States.
| | - Peter R Kvietys
- Department of Physiological Sciences, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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Haberkorn SM, Jacoby C, Ding Z, Keul P, Bönner F, Polzin A, Levkau B, Schrader J, Kelm M, Flögel U. Cardiovascular Magnetic Resonance Relaxometry Predicts Regional Functional Outcome After Experimental Myocardial Infarction. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.006025. [PMID: 28790121 DOI: 10.1161/circimaging.116.006025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 06/21/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cardiovascular magnetic resonance with gadolinium-based contrast agents has established as gold standard for tissue characterization after myocardial infarction (MI). Beyond accurate diagnosis, the value of cardiovascular magnetic resonance to predict the outcome after MI has yet to be substantiated. METHODS AND RESULTS Recent cardiovascular magnetic resonance approaches were systematically compared for quantification of tissue injury and functional impairment after MI using murine models with permanent left anterior descending coronary artery ligation (n=14) or 50 minutes ischemia/reperfusion (n=13). Cardiovascular magnetic resonance included native/postcontrast T1 maps, T2 maps, and late gadolinium enhancement at days 1 and 21 post-MI. For regional correlation of parametric and functional measures, the left ventricle was analyzed over 200 sectors. For T1 mapping, we used retrospective triggering with variable flip angle analysis. Sectoral analysis of native T1 maps already revealed in the acute phase after MI substantial discrepancies in myocardial tissue texture between the 2 MI models (native T1 day 1: permanent ligation, 1280.0±162.6 ms; ischemia/reperfusion, 1115.0±140.5 ms; P<0.001; n=14/13), which were later associated with differential functional outcome (left ventricular ejection fraction day 21: permanent ligation, 24.5±7.0%; ischemia/reperfusion, 33.7±11.6%; P<0.05; n=14/13). At this early time, any other parameter was indicative for the subsequent worsening of left ventricular ejection fraction in permanent ligation mice. Linear regression of acute individual measures with contractile function in corresponding areas at day 21 demonstrated for early native T1 values the best correlation with the later functional impairment (R2 =0.94). CONCLUSIONS The present T1 mapping approach permits accurate characterization of local tissue injury and holds the potential for sensitive and graduated prognosis of the functional outcome after MI without gadolinium-based contrast agents.
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Affiliation(s)
- Sebastian M Haberkorn
- From the Department of Molecular Cardiology (S.M.H., Z.D., J.S., U.F.) and Cardiovascular Research Institute Düsseldorf, Germany (J.S., M.K., U.F.), Heinrich Heine University Düsseldorf, Germany; Department of Cardiology, Pneumology and Angiology, University Hospital Düsseldorf, Germany (S.M.H., C.J., F.B., A.P., M.K., U.F.); and Department of Pathophysiology, University Hospital Essen, Germany (P.K., B.L.)
| | - Christoph Jacoby
- From the Department of Molecular Cardiology (S.M.H., Z.D., J.S., U.F.) and Cardiovascular Research Institute Düsseldorf, Germany (J.S., M.K., U.F.), Heinrich Heine University Düsseldorf, Germany; Department of Cardiology, Pneumology and Angiology, University Hospital Düsseldorf, Germany (S.M.H., C.J., F.B., A.P., M.K., U.F.); and Department of Pathophysiology, University Hospital Essen, Germany (P.K., B.L.)
| | - Zhaoping Ding
- From the Department of Molecular Cardiology (S.M.H., Z.D., J.S., U.F.) and Cardiovascular Research Institute Düsseldorf, Germany (J.S., M.K., U.F.), Heinrich Heine University Düsseldorf, Germany; Department of Cardiology, Pneumology and Angiology, University Hospital Düsseldorf, Germany (S.M.H., C.J., F.B., A.P., M.K., U.F.); and Department of Pathophysiology, University Hospital Essen, Germany (P.K., B.L.)
| | - Petra Keul
- From the Department of Molecular Cardiology (S.M.H., Z.D., J.S., U.F.) and Cardiovascular Research Institute Düsseldorf, Germany (J.S., M.K., U.F.), Heinrich Heine University Düsseldorf, Germany; Department of Cardiology, Pneumology and Angiology, University Hospital Düsseldorf, Germany (S.M.H., C.J., F.B., A.P., M.K., U.F.); and Department of Pathophysiology, University Hospital Essen, Germany (P.K., B.L.)
| | - Florian Bönner
- From the Department of Molecular Cardiology (S.M.H., Z.D., J.S., U.F.) and Cardiovascular Research Institute Düsseldorf, Germany (J.S., M.K., U.F.), Heinrich Heine University Düsseldorf, Germany; Department of Cardiology, Pneumology and Angiology, University Hospital Düsseldorf, Germany (S.M.H., C.J., F.B., A.P., M.K., U.F.); and Department of Pathophysiology, University Hospital Essen, Germany (P.K., B.L.)
| | - Amin Polzin
- From the Department of Molecular Cardiology (S.M.H., Z.D., J.S., U.F.) and Cardiovascular Research Institute Düsseldorf, Germany (J.S., M.K., U.F.), Heinrich Heine University Düsseldorf, Germany; Department of Cardiology, Pneumology and Angiology, University Hospital Düsseldorf, Germany (S.M.H., C.J., F.B., A.P., M.K., U.F.); and Department of Pathophysiology, University Hospital Essen, Germany (P.K., B.L.)
| | - Bodo Levkau
- From the Department of Molecular Cardiology (S.M.H., Z.D., J.S., U.F.) and Cardiovascular Research Institute Düsseldorf, Germany (J.S., M.K., U.F.), Heinrich Heine University Düsseldorf, Germany; Department of Cardiology, Pneumology and Angiology, University Hospital Düsseldorf, Germany (S.M.H., C.J., F.B., A.P., M.K., U.F.); and Department of Pathophysiology, University Hospital Essen, Germany (P.K., B.L.)
| | - Jürgen Schrader
- From the Department of Molecular Cardiology (S.M.H., Z.D., J.S., U.F.) and Cardiovascular Research Institute Düsseldorf, Germany (J.S., M.K., U.F.), Heinrich Heine University Düsseldorf, Germany; Department of Cardiology, Pneumology and Angiology, University Hospital Düsseldorf, Germany (S.M.H., C.J., F.B., A.P., M.K., U.F.); and Department of Pathophysiology, University Hospital Essen, Germany (P.K., B.L.)
| | - Malte Kelm
- From the Department of Molecular Cardiology (S.M.H., Z.D., J.S., U.F.) and Cardiovascular Research Institute Düsseldorf, Germany (J.S., M.K., U.F.), Heinrich Heine University Düsseldorf, Germany; Department of Cardiology, Pneumology and Angiology, University Hospital Düsseldorf, Germany (S.M.H., C.J., F.B., A.P., M.K., U.F.); and Department of Pathophysiology, University Hospital Essen, Germany (P.K., B.L.)
| | - Ulrich Flögel
- From the Department of Molecular Cardiology (S.M.H., Z.D., J.S., U.F.) and Cardiovascular Research Institute Düsseldorf, Germany (J.S., M.K., U.F.), Heinrich Heine University Düsseldorf, Germany; Department of Cardiology, Pneumology and Angiology, University Hospital Düsseldorf, Germany (S.M.H., C.J., F.B., A.P., M.K., U.F.); and Department of Pathophysiology, University Hospital Essen, Germany (P.K., B.L.).
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Amier RP, Tijssen RYG, Teunissen PFA, Fernández-Jiménez R, Pizarro G, García-Lunar I, Bastante T, van de Ven PM, Beek AM, Smulders MW, Bekkers SCAM, van Royen N, Ibanez B, Nijveldt R. Predictors of Intramyocardial Hemorrhage After Reperfused ST-Segment Elevation Myocardial Infarction. J Am Heart Assoc 2017; 6:JAHA.117.005651. [PMID: 28862937 PMCID: PMC5586425 DOI: 10.1161/jaha.117.005651] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Findings from recent studies show that microvascular injury consists of microvascular destruction and intramyocardial hemorrhage (IMH). Patients with ST‐segment elevation myocardial infarction (STEMI) with IMH show poorer prognoses than patients without IMH. Knowledge on predictors for the occurrence of IMH after STEMI is lacking. The current study aimed to investigate the prevalence and extent of IMH in patients with STEMI and its relation with periprocedural and clinical variables. Methods and Results A multicenter observational cohort study was performed in patients with successfully reperfused STEMI with cardiovascular magnetic resonance examination 5.5±1.8 days after percutaneous coronary intervention. Microvascular injury was visualized using late gadolinium enhancement and T2‐weighted cardiovascular magnetic resonance imaging for microvascular obstruction and IMH, respectively. The median was used as the cutoff value to divide the study population with presence of IMH into mild or extensive IMH. Clinical and periprocedural parameters were studied in relation to occurrence of IMH and extensive IMH, respectively. Of the 410 patients, 54% had IMH. The presence of IMH was independently associated with anterior infarction (odds ratio, 2.96; 95% CI, 1.73–5.06 [P<0.001]) and periprocedural glycoprotein IIb/IIIa inhibitor treatment (odds ratio, 2.67; 95% CI, 1.49–4.80 [P<0.001]). Extensive IMH was independently associated with anterior infarction (odds ratio, 3.76; 95% CI, 1.91–7.43 [P<0.001]). Presence and extent of IMH was associated with larger infarct size, greater extent of microvascular obstruction, larger left ventricular dimensions, and lower left ventricular ejection fraction (all P<0.001). Conclusions Occurrence of IMH was associated with anterior infarction and glycoprotein IIb/IIIa inhibitor treatment. Extensive IMH was associated with anterior infarction. IMH was associated with more severe infarction and worse short‐term left ventricular function in patients with STEMI.
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Affiliation(s)
- Raquel P Amier
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Ruben Y G Tijssen
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Paul F A Teunissen
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Rodrigo Fernández-Jiménez
- Centro Nacional Investigaciones Cardiovasculares Carlos III, Madrid, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Gonzalo Pizarro
- Centro Nacional Investigaciones Cardiovasculares Carlos III, Madrid, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Inés García-Lunar
- Centro Nacional Investigaciones Cardiovasculares Carlos III, Madrid, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Teresa Bastante
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
| | - Aernout M Beek
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Martijn W Smulders
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Niels van Royen
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Borja Ibanez
- Centro Nacional Investigaciones Cardiovasculares Carlos III, Madrid, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Robin Nijveldt
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
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77
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Garg P, Plein S. Native T1 Mapping. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.117.006767. [DOI: 10.1161/circimaging.117.006767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Pankaj Garg
- From the Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom
| | - Sven Plein
- From the Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom
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78
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Liu D, Borlotti A, Viliani D, Jerosch-Herold M, Alkhalil M, De Maria GL, Fahrni G, Dawkins S, Wijesurendra R, Francis J, Ferreira V, Piechnik S, Robson MD, Banning A, Choudhury R, Neubauer S, Channon K, Kharbanda R, Dall'Armellina E. CMR Native T1 Mapping Allows Differentiation of Reversible Versus Irreversible Myocardial Damage in ST-Segment-Elevation Myocardial Infarction: An OxAMI Study (Oxford Acute Myocardial Infarction). Circ Cardiovasc Imaging 2017; 10:e005986. [PMID: 28798137 PMCID: PMC5555391 DOI: 10.1161/circimaging.116.005986] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 07/12/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND CMR T1 mapping is a quantitative imaging technique allowing the assessment of myocardial injury early after ST-segment-elevation myocardial infarction. We sought to investigate the ability of acute native T1 mapping to differentiate reversible and irreversible myocardial injury and its predictive value for left ventricular remodeling. METHODS AND RESULTS Sixty ST-segment-elevation myocardial infarction patients underwent acute and 6-month 3T CMR, including cine, T2-weighted (T2W) imaging, native shortened modified look-locker inversion recovery T1 mapping, rest first pass perfusion, and late gadolinium enhancement. T1 cutoff values for oedematous versus necrotic myocardium were identified as 1251 ms and 1400 ms, respectively, with prediction accuracy of 96.7% (95% confidence interval, 82.8% to 99.9%). Using the proposed threshold of 1400 ms, the volume of irreversibly damaged tissue was in good agreement with the 6-month late gadolinium enhancement volume (r=0.99) and correlated strongly with the log area under the curve troponin (r=0.80) and strongly with 6-month ejection fraction (r=-0.73). Acute T1 values were a strong predictor of 6-month wall thickening compared with late gadolinium enhancement. CONCLUSIONS Acute native shortened modified look-locker inversion recovery T1 mapping differentiates reversible and irreversible myocardial injury, and it is a strong predictor of left ventricular remodeling in ST-segment-elevation myocardial infarction. A single CMR acquisition of native T1 mapping could potentially represent a fast, safe, and accurate method for early stratification of acute patients in need of more aggressive treatment. Further confirmatory studies will be needed.
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Affiliation(s)
- Dan Liu
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Headley Way, United Kingdom (D.L., A.B., D.V., M.A., G.L.D.M., G.F., S.D., R.W., J.F., V.F., S.P., M.D.R., R.C., S.N., E.D.A.); Department of Cardiovascular Medicine, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, United Kingdom (A.B., K.C., R.K.); and Department of Radiology, Brigham and Women's Hospital, Boston, MA (M.J.-H.)
| | - Alessandra Borlotti
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Headley Way, United Kingdom (D.L., A.B., D.V., M.A., G.L.D.M., G.F., S.D., R.W., J.F., V.F., S.P., M.D.R., R.C., S.N., E.D.A.); Department of Cardiovascular Medicine, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, United Kingdom (A.B., K.C., R.K.); and Department of Radiology, Brigham and Women's Hospital, Boston, MA (M.J.-H.)
| | - Dafne Viliani
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Headley Way, United Kingdom (D.L., A.B., D.V., M.A., G.L.D.M., G.F., S.D., R.W., J.F., V.F., S.P., M.D.R., R.C., S.N., E.D.A.); Department of Cardiovascular Medicine, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, United Kingdom (A.B., K.C., R.K.); and Department of Radiology, Brigham and Women's Hospital, Boston, MA (M.J.-H.)
| | - Michael Jerosch-Herold
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Headley Way, United Kingdom (D.L., A.B., D.V., M.A., G.L.D.M., G.F., S.D., R.W., J.F., V.F., S.P., M.D.R., R.C., S.N., E.D.A.); Department of Cardiovascular Medicine, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, United Kingdom (A.B., K.C., R.K.); and Department of Radiology, Brigham and Women's Hospital, Boston, MA (M.J.-H.)
| | - Mohammad Alkhalil
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Headley Way, United Kingdom (D.L., A.B., D.V., M.A., G.L.D.M., G.F., S.D., R.W., J.F., V.F., S.P., M.D.R., R.C., S.N., E.D.A.); Department of Cardiovascular Medicine, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, United Kingdom (A.B., K.C., R.K.); and Department of Radiology, Brigham and Women's Hospital, Boston, MA (M.J.-H.)
| | - Giovanni Luigi De Maria
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Headley Way, United Kingdom (D.L., A.B., D.V., M.A., G.L.D.M., G.F., S.D., R.W., J.F., V.F., S.P., M.D.R., R.C., S.N., E.D.A.); Department of Cardiovascular Medicine, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, United Kingdom (A.B., K.C., R.K.); and Department of Radiology, Brigham and Women's Hospital, Boston, MA (M.J.-H.)
| | - Gregor Fahrni
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Headley Way, United Kingdom (D.L., A.B., D.V., M.A., G.L.D.M., G.F., S.D., R.W., J.F., V.F., S.P., M.D.R., R.C., S.N., E.D.A.); Department of Cardiovascular Medicine, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, United Kingdom (A.B., K.C., R.K.); and Department of Radiology, Brigham and Women's Hospital, Boston, MA (M.J.-H.)
| | - Sam Dawkins
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Headley Way, United Kingdom (D.L., A.B., D.V., M.A., G.L.D.M., G.F., S.D., R.W., J.F., V.F., S.P., M.D.R., R.C., S.N., E.D.A.); Department of Cardiovascular Medicine, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, United Kingdom (A.B., K.C., R.K.); and Department of Radiology, Brigham and Women's Hospital, Boston, MA (M.J.-H.)
| | - Rohan Wijesurendra
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Headley Way, United Kingdom (D.L., A.B., D.V., M.A., G.L.D.M., G.F., S.D., R.W., J.F., V.F., S.P., M.D.R., R.C., S.N., E.D.A.); Department of Cardiovascular Medicine, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, United Kingdom (A.B., K.C., R.K.); and Department of Radiology, Brigham and Women's Hospital, Boston, MA (M.J.-H.)
| | - Jane Francis
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Headley Way, United Kingdom (D.L., A.B., D.V., M.A., G.L.D.M., G.F., S.D., R.W., J.F., V.F., S.P., M.D.R., R.C., S.N., E.D.A.); Department of Cardiovascular Medicine, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, United Kingdom (A.B., K.C., R.K.); and Department of Radiology, Brigham and Women's Hospital, Boston, MA (M.J.-H.)
| | - Vanessa Ferreira
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Headley Way, United Kingdom (D.L., A.B., D.V., M.A., G.L.D.M., G.F., S.D., R.W., J.F., V.F., S.P., M.D.R., R.C., S.N., E.D.A.); Department of Cardiovascular Medicine, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, United Kingdom (A.B., K.C., R.K.); and Department of Radiology, Brigham and Women's Hospital, Boston, MA (M.J.-H.)
| | - Stefan Piechnik
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Headley Way, United Kingdom (D.L., A.B., D.V., M.A., G.L.D.M., G.F., S.D., R.W., J.F., V.F., S.P., M.D.R., R.C., S.N., E.D.A.); Department of Cardiovascular Medicine, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, United Kingdom (A.B., K.C., R.K.); and Department of Radiology, Brigham and Women's Hospital, Boston, MA (M.J.-H.)
| | - Matthew D Robson
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Headley Way, United Kingdom (D.L., A.B., D.V., M.A., G.L.D.M., G.F., S.D., R.W., J.F., V.F., S.P., M.D.R., R.C., S.N., E.D.A.); Department of Cardiovascular Medicine, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, United Kingdom (A.B., K.C., R.K.); and Department of Radiology, Brigham and Women's Hospital, Boston, MA (M.J.-H.)
| | - Adrian Banning
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Headley Way, United Kingdom (D.L., A.B., D.V., M.A., G.L.D.M., G.F., S.D., R.W., J.F., V.F., S.P., M.D.R., R.C., S.N., E.D.A.); Department of Cardiovascular Medicine, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, United Kingdom (A.B., K.C., R.K.); and Department of Radiology, Brigham and Women's Hospital, Boston, MA (M.J.-H.)
| | - Robin Choudhury
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Headley Way, United Kingdom (D.L., A.B., D.V., M.A., G.L.D.M., G.F., S.D., R.W., J.F., V.F., S.P., M.D.R., R.C., S.N., E.D.A.); Department of Cardiovascular Medicine, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, United Kingdom (A.B., K.C., R.K.); and Department of Radiology, Brigham and Women's Hospital, Boston, MA (M.J.-H.)
| | - Stefan Neubauer
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Headley Way, United Kingdom (D.L., A.B., D.V., M.A., G.L.D.M., G.F., S.D., R.W., J.F., V.F., S.P., M.D.R., R.C., S.N., E.D.A.); Department of Cardiovascular Medicine, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, United Kingdom (A.B., K.C., R.K.); and Department of Radiology, Brigham and Women's Hospital, Boston, MA (M.J.-H.)
| | - Keith Channon
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Headley Way, United Kingdom (D.L., A.B., D.V., M.A., G.L.D.M., G.F., S.D., R.W., J.F., V.F., S.P., M.D.R., R.C., S.N., E.D.A.); Department of Cardiovascular Medicine, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, United Kingdom (A.B., K.C., R.K.); and Department of Radiology, Brigham and Women's Hospital, Boston, MA (M.J.-H.)
| | - Rajesh Kharbanda
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Headley Way, United Kingdom (D.L., A.B., D.V., M.A., G.L.D.M., G.F., S.D., R.W., J.F., V.F., S.P., M.D.R., R.C., S.N., E.D.A.); Department of Cardiovascular Medicine, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, United Kingdom (A.B., K.C., R.K.); and Department of Radiology, Brigham and Women's Hospital, Boston, MA (M.J.-H.)
| | - Erica Dall'Armellina
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Headley Way, United Kingdom (D.L., A.B., D.V., M.A., G.L.D.M., G.F., S.D., R.W., J.F., V.F., S.P., M.D.R., R.C., S.N., E.D.A.); Department of Cardiovascular Medicine, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, United Kingdom (A.B., K.C., R.K.); and Department of Radiology, Brigham and Women's Hospital, Boston, MA (M.J.-H.).
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Bulluck H, Hammond-Haley M, Fontana M, Knight DS, Sirker A, Herrey AS, Manisty C, Kellman P, Moon JC, Hausenloy DJ. Quantification of both the area-at-risk and acute myocardial infarct size in ST-segment elevation myocardial infarction using T1-mapping. J Cardiovasc Magn Reson 2017; 19:57. [PMID: 28764773 PMCID: PMC5539889 DOI: 10.1186/s12968-017-0370-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 07/04/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND A comprehensive cardiovascular magnetic resonance (CMR) in reperfused ST-segment myocardial infarction (STEMI) patients can be challenging to perform and can be time-consuming. We aimed to investigate whether native T1-mapping can accurately delineate the edema-based area-at-risk (AAR) and post-contrast T1-mapping and synthetic late gadolinium (LGE) images can quantify MI size at 1.5 T. Conventional LGE imaging and T2-mapping could then be omitted, thereby shortening the scan duration. METHODS Twenty-eight STEMI patients underwent a CMR scan at 1.5 T, 3 ± 1 days following primary percutaneous coronary intervention. The AAR was quantified using both native T1 and T2-mapping. MI size was quantified using conventional LGE, post-contrast T1-mapping and synthetic magnitude-reconstructed inversion recovery (MagIR) LGE and synthetic phase-sensitive inversion recovery (PSIR) LGE, derived from the post-contrast T1 maps. RESULTS Native T1-mapping performed as well as T2-mapping in delineating the AAR (41.6 ± 11.9% of the left ventricle [% LV] versus 41.7 ± 12.2% LV, P = 0.72; R2 0.97; ICC 0.986 (0.969-0.993); bias -0.1 ± 4.2% LV). There were excellent correlation and inter-method agreement with no bias, between MI size by conventional LGE, synthetic MagIR LGE (bias 0.2 ± 2.2%LV, P = 0.35), synthetic PSIR LGE (bias 0.4 ± 2.2% LV, P = 0.060) and post-contrast T1-mapping (bias 0.3 ± 1.8% LV, P = 0.10). The mean scan duration was 58 ± 4 min. Not performing T2 mapping (6 ± 1 min) and conventional LGE (10 ± 1 min) would shorten the CMR study by 15-20 min. CONCLUSIONS T1-mapping can accurately quantify both the edema-based AAR (using native T1 maps) and acute MI size (using post-contrast T1 maps) in STEMI patients without major cardiovascular risk factors. This approach would shorten the duration of a comprehensive CMR study without significantly compromising on data acquisition and would obviate the need to perform T2 maps and LGE imaging.
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Affiliation(s)
- Heerajnarain Bulluck
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, London, UK
| | - Matthew Hammond-Haley
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, London, UK
| | - Marianna Fontana
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, UK
| | - Daniel S. Knight
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, UK
| | - Alex Sirker
- The National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, UK
- Barts Heart Centre, St Bartholomew’s Hospital, London, UK
| | - Anna S. Herrey
- Barts Heart Centre, St Bartholomew’s Hospital, London, UK
| | | | - Peter Kellman
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, USA
| | - James C. Moon
- The National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, UK
- Barts Heart Centre, St Bartholomew’s Hospital, London, UK
| | - Derek J. Hausenloy
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, London, UK
- The National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, UK
- Barts Heart Centre, St Bartholomew’s Hospital, London, UK
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore, Singapore
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
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80
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Fernández-Jiménez R, Barreiro-Pérez M, Martin-García A, Sánchez-González J, Agüero J, Galán-Arriola C, García-Prieto J, Díaz-Pelaez E, Vara P, Martinez I, Zamarro I, Garde B, Sanz J, Fuster V, Sánchez PL, Ibanez B. Dynamic Edematous Response of the Human Heart to Myocardial Infarction: Implications for Assessing Myocardial Area at Risk and Salvage. Circulation 2017; 136:1288-1300. [PMID: 28687712 PMCID: PMC5625960 DOI: 10.1161/circulationaha.116.025582] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 06/26/2017] [Indexed: 01/28/2023]
Abstract
Supplemental Digital Content is available in the text. Background: Clinical protocols aimed to characterize the post–myocardial infarction (MI) heart by cardiac magnetic resonance (CMR) need to be standardized to take account of dynamic biological phenomena evolving early after the index ischemic event. Here, we evaluated the time course of edema reaction in patients with ST-segment–elevation MI by CMR and assessed its implications for myocardium-at-risk (MaR) quantification both in patients and in a large-animal model. Methods: A total of 16 patients with anterior ST-segment–elevation MI successfully treated by primary angioplasty and 16 matched controls were prospectively recruited. In total, 94 clinical CMR examinations were performed: patients with ST-segment–elevation MI were serially scanned (within the first 3 hours after reperfusion and at 1, 4, 7, and 40 days), and controls were scanned only once. T2 relaxation time in the myocardium (T2 mapping) and the extent of edema on T2-weighted short-tau triple inversion-recovery (ie, CMR-MaR) were evaluated at all time points. In the experimental study, 20 pigs underwent 40-minute ischemia/reperfusion followed by serial CMR examinations at 120 minutes and 1, 4, and 7 days after reperfusion. Reference MaR was assessed by contrast-multidetector computed tomography during the index coronary occlusion. Generalized linear mixed models were used to take account of repeated measurements. Results: In humans, T2 relaxation time in the ischemic myocardium declines significantly from early after reperfusion to 24 hours, and then increases up to day 4, reaching a plateau from which it decreases from day 7. Consequently, edema extent measured by T2-weighted short-tau triple inversion-recovery (CMR-MaR) varied with the timing of the CMR examination. These findings were confirmed in the experimental model by showing that only CMR-MaR values for day 4 and day 7 postreperfusion, coinciding with the deferred edema wave, were similar to values measured by reference contrast-multidetector computed tomography. Conclusions: Post-MI edema in patients follows a bimodal pattern that affects CMR estimates of MaR. Dynamic changes in post–ST-segment–elevation MI edema highlight the need for standardization of CMR timing to retrospectively delineate MaR and quantify myocardial salvage. According to the present clinical and experimental data, a time window between days 4 and 7 post-MI seems a good compromise solution for standardization. Further studies are needed to study the effect of other factors on these variables.
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Affiliation(s)
- Rodrigo Fernández-Jiménez
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.)
| | - Manuel Barreiro-Pérez
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.)
| | - Ana Martin-García
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.)
| | - Javier Sánchez-González
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.)
| | - Jaume Agüero
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.)
| | - Carlos Galán-Arriola
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.)
| | - Jaime García-Prieto
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.)
| | - Elena Díaz-Pelaez
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.)
| | - Pedro Vara
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.)
| | - Irene Martinez
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.)
| | - Ivan Zamarro
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.)
| | - Beatriz Garde
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.)
| | - Javier Sanz
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.)
| | - Valentin Fuster
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.)
| | - Pedro L Sánchez
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.).
| | - Borja Ibanez
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.).
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Bulluck H, Hausenloy DJ. Mapping Myocardial Salvage Index by Extracellular Volume Fraction: Are We There Yet? Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.117.006680. [PMID: 28674086 DOI: 10.1161/circimaging.117.006680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Heerajnarain Bulluck
- From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., D.J.H.); The National Institute of Health Research, Biomedical Research Centre, University College London Hospitals, United Kingdom (H.B., D.J.H.); Papworth Hospital NHS Trust, Cambridge, United Kingdom (H.B.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (D.J.H.); National Heart Research Institute Singapore, National Heart Centre, Singapore (D.J.H.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (D.J.H.); and Yong Loo Lin School of Medicine, National University of Singapore (D.J.H.)
| | - Derek J Hausenloy
- From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., D.J.H.); The National Institute of Health Research, Biomedical Research Centre, University College London Hospitals, United Kingdom (H.B., D.J.H.); Papworth Hospital NHS Trust, Cambridge, United Kingdom (H.B.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (D.J.H.); National Heart Research Institute Singapore, National Heart Centre, Singapore (D.J.H.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (D.J.H.); and Yong Loo Lin School of Medicine, National University of Singapore (D.J.H.).
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82
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Ghugre NR, Pop M, Thomas R, Newbigging S, Qi X, Barry J, Strauss BH, Wright GA. Hemorrhage promotes inflammation and myocardial damage following acute myocardial infarction: insights from a novel preclinical model and cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2017; 19:50. [PMID: 28676061 PMCID: PMC5496389 DOI: 10.1186/s12968-017-0361-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 05/09/2017] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Myocardial hemorrhage is a frequent complication following reperfusion in acute myocardial infarction and is predictive of adverse outcomes. However, it remains unsettled whether hemorrhage is simply a marker of a severe initial ischemic insult or directly contributes to downstream myocardial damage. Our objective was to evaluate the contribution of hemorrhage towards inflammation, microvascular obstruction and infarct size in a novel porcine model of hemorrhagic myocardial infarction using cardiovascular magnetic resonance (CMR). METHODS Myocardial hemorrhage was induced via direct intracoronary injection of collagenase in a novel porcine model of ischemic injury. Animals (N = 27) were subjected to coronary balloon occlusion followed by reperfusion and divided into three groups (N = 9/group): 8 min ischemia with collagenase (+HEM); 45 min infarction with saline (I-HEM); and 45 min infarction with collagenase (I+HEM). Comprehensive CMR was performed on a 3 T scanner at baseline and 24 h post-intervention. Cardiac function was quantified by cine imaging, edema/inflammation by T2 mapping, hemorrhage by T2* mapping and infarct/microvascular obstruction size by gadolinium enhancement. Animals were subsequently sacrificed and explanted hearts underwent histopathological assessment for ischemic damage and inflammation. RESULTS At 24 h, the +HEM group induced only hemorrhage, the I-HEM group resulted in a non-hemorrhagic infarction, and the I+HEM group resulted in infarction and hemorrhage. Notably, the I+HEM group demonstrated greater hemorrhage and edema, larger infarct size and higher incidence of microvascular obstruction. Interestingly, hemorrhage alone (+HEM) also resulted in an observable inflammatory response, similar to that arising from a mild ischemic insult (I-HEM). CMR findings were in good agreement with histological staining patterns. CONCLUSIONS Hemorrhage is not simply a bystander, but an active modulator of tissue response, including inflammation and microvascular and myocardial damage beyond the initial ischemic insult. A mechanistic understanding of the pathophysiology of reperfusion hemorrhage will potentially aid better management of high-risk patients who are prone to adverse long-term outcomes.
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Affiliation(s)
- Nilesh R. Ghugre
- Physical Sciences Platform, Sunnybrook Research Institute, 2075 Bayview Avenue, Room M7-510, Toronto, ON M4N 3M5 Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON Canada
- Schulich Heart Research Program, Sunnybrook Health Sciences Centre, Toronto, ON Canada
| | - Mihaela Pop
- Physical Sciences Platform, Sunnybrook Research Institute, 2075 Bayview Avenue, Room M7-510, Toronto, ON M4N 3M5 Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON Canada
- Schulich Heart Research Program, Sunnybrook Health Sciences Centre, Toronto, ON Canada
| | - Reuben Thomas
- Physical Sciences Platform, Sunnybrook Research Institute, 2075 Bayview Avenue, Room M7-510, Toronto, ON M4N 3M5 Canada
| | - Susan Newbigging
- The Toronto Centre for Phenogenomics, Mount Sinai Hospital, Toronto, ON Canada
| | - Xiuling Qi
- Physical Sciences Platform, Sunnybrook Research Institute, 2075 Bayview Avenue, Room M7-510, Toronto, ON M4N 3M5 Canada
| | - Jennifer Barry
- Physical Sciences Platform, Sunnybrook Research Institute, 2075 Bayview Avenue, Room M7-510, Toronto, ON M4N 3M5 Canada
| | - Bradley H. Strauss
- Schulich Heart Research Program, Sunnybrook Health Sciences Centre, Toronto, ON Canada
| | - Graham A. Wright
- Physical Sciences Platform, Sunnybrook Research Institute, 2075 Bayview Avenue, Room M7-510, Toronto, ON M4N 3M5 Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON Canada
- Schulich Heart Research Program, Sunnybrook Health Sciences Centre, Toronto, ON Canada
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83
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de Waard GA, Fahrni G, de Wit D, Kitabata H, Williams R, Patel N, Teunissen PF, van de Ven PM, Umman S, Knaapen P, Perera D, Akasaka T, Sezer M, Kharbanda RK, van Royen N. Hyperaemic microvascular resistance predicts clinical outcome and microvascular injury after myocardial infarction. Heart 2017; 104:127-134. [PMID: 28663361 DOI: 10.1136/heartjnl-2017-311431] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 05/09/2017] [Accepted: 05/09/2017] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Early detection of microvascular dysfunction after acute myocardial infarction (AMI) could identify patients at high risk of adverse clinical outcome, who may benefit from adjunctive treatment. Our objective was to compare invasively measured coronary flow reserve (CFR) and hyperaemic microvascular resistance (HMR) for their predictive power of long-term clinical outcome and cardiac magnetic resonance (CMR)-defined microvascular injury (MVI). METHODS Simultaneous intracoronary Doppler flow velocity and pressure measurements acquired immediately after revascularisation for AMI from five centres were pooled. Clinical follow-up was completed for 176 patients (mean age 60±10 years; 140(80%) male; ST-elevation myocardial infarction (STEMI) 130(74%) and non-ST-segment elevation myocardial infarction 46(26%)) with median follow-up time of 3.2 years. In 110 patients with STEMI, additional CMR was performed. RESULTS The composite end point of death and hospitalisation for heart failure occurred in 17 patients (10%). Optimal cut-off values to predict the composite end point were 1.5 for CFR and 3.0 mm Hg cm-1•s for HMR. CFR <1.5 was predictive for the composite end point (HR 3.5;95% CI 1.1 to 10.8), but not for its individual components. HMR ≥3.0 mm Hg cm-1 s was predictive for the composite end point (HR 7.0;95% CI 1.5 to 33.7) as well as both individual components. HMR had significantly greater area under the receiver operating characteristic curve for MVI than CFR. HMR remained an independent predictor of adverse clinical outcome and MVI, whereas CFR did not. CONCLUSIONS HMR measured immediately following percutaneous coronary intervention for AMI with a cut-off value of 3.0 mm Hg cm-1 s, identifies patients with MVI who are at high risk of adverse clinical outcome. For this purpose, HMR is superior to CFR.
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Affiliation(s)
- Guus A de Waard
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Gregor Fahrni
- Oxford Heart Centre, Oxford University Hospitals, Oxford, UK
| | - Douwe de Wit
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Hironori Kitabata
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Rupert Williams
- Cardiovascular Division, British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, King's College London, London, UK
| | - Niket Patel
- Oxford Heart Centre, Oxford University Hospitals, Oxford, UK
| | - Paul F Teunissen
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Peter M van de Ven
- Department of Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Sabahattin Umman
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Paul Knaapen
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Divaka Perera
- Cardiovascular Division, British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, King's College London, London, UK
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Murat Sezer
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | - Niels van Royen
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
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Fernández-Jiménez R, Galán-Arriola C, Sánchez-González J, Agüero J, López-Martín GJ, Gomez-Talavera S, Garcia-Prieto J, Benn A, Molina-Iracheta A, Barreiro-Pérez M, Martin-García A, García-Lunar I, Pizarro G, Sanz J, Sánchez PL, Fuster V, Ibanez B. Effect of Ischemia Duration and Protective Interventions on the Temporal Dynamics of Tissue Composition After Myocardial Infarction. Circ Res 2017; 121:439-450. [PMID: 28596216 PMCID: PMC5542781 DOI: 10.1161/circresaha.117.310901] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 06/02/2017] [Accepted: 06/08/2017] [Indexed: 01/18/2023]
Abstract
Supplemental Digital Content is available in the text. Rationale: The impact of cardioprotective strategies and ischemia duration on postischemia/reperfusion (I/R) myocardial tissue composition (edema, myocardium at risk, infarct size, salvage, intramyocardial hemorrhage, and microvascular obstruction) is not well understood. Objective: To study the effect of ischemia duration and protective interventions on the temporal dynamics of myocardial tissue composition in a translational animal model of I/R by the use of state-of-the-art imaging technology. Methods and Results: Four 5-pig groups underwent different I/R protocols: 40-minute I/R (prolonged ischemia, controls), 20-minute I/R (short-duration ischemia), prolonged ischemia preceded by preconditioning, or prolonged ischemia followed by postconditioning. Serial cardiac magnetic resonance (CMR)-based tissue characterization was done in all pigs at baseline and at 120 minutes, day 1, day 4, and day 7 after I/R. Reference myocardium at risk was assessed by multidetector computed tomography during the index coronary occlusion. After the final CMR, hearts were excised and processed for water content quantification and histology. Five additional healthy pigs were euthanized after baseline CMR as reference. Edema formation followed a bimodal pattern in all 40-minute I/R pigs, regardless of cardioprotective strategy and the degree of intramyocardial hemorrhage or microvascular obstruction. The hyperacute edematous wave was ameliorated only in pigs showing cardioprotection (ie, those undergoing short-duration ischemia or preconditioning). In all groups, CMR-measured edema was barely detectable at 24 hours postreperfusion. The deferred healing-related edematous wave was blunted or absent in pigs undergoing preconditioning or short-duration ischemia, respectively. CMR-measured infarct size declined progressively after reperfusion in all groups. CMR-measured myocardial salvage, and the extent of intramyocardial hemorrhage and microvascular obstruction varied dramatically according to CMR timing, ischemia duration, and cardioprotective strategy. Conclusions: Cardioprotective therapies, duration of index ischemia, and the interplay between these greatly influence temporal dynamics and extent of tissue composition changes after I/R. Consequently, imaging techniques and protocols for assessing edema, myocardium at risk, infarct size, salvage, intramyocardial hemorrhage, and microvascular obstruction should be standardized accordingly.
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Affiliation(s)
- Rodrigo Fernández-Jiménez
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Carlos Galán-Arriola
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Javier Sánchez-González
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Jaume Agüero
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Gonzalo J López-Martín
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Sandra Gomez-Talavera
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Jaime Garcia-Prieto
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Austin Benn
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Antonio Molina-Iracheta
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Manuel Barreiro-Pérez
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Ana Martin-García
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Inés García-Lunar
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Gonzalo Pizarro
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Javier Sanz
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Pedro L Sánchez
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Valentin Fuster
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Borja Ibanez
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.).
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Stoffers RH, Madden M, Shahid M, Contijoch F, Solomon J, Pilla JJ, Gorman JH, Gorman RC, Witschey WR. Assessment of myocardial injury after reperfused infarction by T1ρ cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2017; 19:17. [PMID: 28196494 PMCID: PMC5310026 DOI: 10.1186/s12968-017-0332-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 01/24/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The evolution of T1ρ and of other endogenous contrast methods (T2, T1) in the first month after reperfused myocardial infarction (MI) is uncertain. We conducted a study of reperfused MI in pigs to serially monitor T1ρ, T2 and T1 relaxation, scar size and transmurality at 1 and 4 weeks post-MI. METHODS Ten Yorkshire swine underwent 90 min of occlusion of the circumflex artery and reperfusion. T1ρ, T2 and native T1 maps and late gadolinium enhanced (LGE) cardiovascular magnetic resonance (CMR) data were collected at 1 week (n = 10) and 4 weeks (n = 5). Semi-automatic FWHM (full width half maximum) thresholding was used to assess scar size and transmurality and compared to histology. Relaxation times and contrast-to-noise ratio were compared in healthy and remote myocardium at 1 and 4 weeks. Linear regression and Bland-Altman was performed to compare infarct size and transmurality. RESULTS Relaxation time differences between infarcted and remote myocardial tissue were ∆T1 (infarct-remote) = 421.3 ± 108.8 (1 week) and 480.0 ± 33.2 ms (4 week), ∆T1ρ = 68.1 ± 11.6 and 74.3 ± 14.2, and ∆T2 = 51.0 ± 10.1 and 59.2 ± 11.4 ms. Contrast-to-noise ratio was CNRT1 = 7.0 ± 3.5 (1 week) and 6.9 ± 2.4 (4 week), CNRT1ρ = 12.0 ± 6.2 and 12.3 ± 3.2, and CNRT2 = 8.0 ± 3.6 and 10.3 ± 5.8. Infarct size was not significantly different for T1ρ, T1 and T2 compared to LGE (p = 0.14) and significantly decreased from 1 to 4 weeks (p < 0.01). Individual infarct size changes were ∆T1ρ = -3.8%, ∆T1 = -3.5% and ∆LGE = -2.8% from 1 - 4 weeks, but there was no observed change in infarct size for T2 or histologically. CONCLUSIONS T1ρ was highly correlated with alterations left ventricle (LV) pathology at 1 and 4 weeks post-MI and therefore it may be a useful method endogenous contrast imaging of infarction.
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Affiliation(s)
- Rutger H. Stoffers
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 1 Silverstein 3400 Spruce Street, Philadelphia, PA USA 19104
- Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, PA USA
| | - Marie Madden
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 1 Silverstein 3400 Spruce Street, Philadelphia, PA USA 19104
| | - Mohammed Shahid
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 1 Silverstein 3400 Spruce Street, Philadelphia, PA USA 19104
| | - Francisco Contijoch
- Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, PA USA
| | - Joseph Solomon
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 1 Silverstein 3400 Spruce Street, Philadelphia, PA USA 19104
| | - James J. Pilla
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 1 Silverstein 3400 Spruce Street, Philadelphia, PA USA 19104
| | - Joseph H. Gorman
- Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, PA USA
| | - Robert C. Gorman
- Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, PA USA
| | - Walter R.T. Witschey
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 1 Silverstein 3400 Spruce Street, Philadelphia, PA USA 19104
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86
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Bulluck H, Rosmini S, Abdel-Gadir A, Bhuva AN, Treibel TA, Fontana M, Gonzalez-Lopez E, Ramlall M, Hamarneh A, Sirker A, Herrey AS, Manisty C, Yellon DM, Moon JC, Hausenloy DJ. Diagnostic performance of T 1 and T 2 mapping to detect intramyocardial hemorrhage in reperfused ST-segment elevation myocardial infarction (STEMI) patients. J Magn Reson Imaging 2017; 46:877-886. [PMID: 28199043 PMCID: PMC5573941 DOI: 10.1002/jmri.25638] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 01/01/2017] [Indexed: 01/26/2023] Open
Abstract
Purpose To investigate the performance of T1 and T2 mapping to detect intramyocardial hemorrhage (IMH) in ST‐segment elevation myocardial infarction (STEMI) patients treated by primary percutaneous coronary intervention (PPCI). Materials and Methods Fifty STEMI patients were prospectively recruited between August 2013 and July 2014 following informed consent. Forty‐eight patients completed a 1.5T cardiac magnetic resonance imaging (MRI) with native T1, T2, and
T2* maps at 4 ± 2 days. Receiver operating characteristic (ROC) analyses were performed to assess the performance of T1 and T2 to detect IMH. Results The mean age was 59 ± 13 years old and 88% (24/48) were male. In all, 39 patients had interpretable
T2* maps and 26/39 (67%) of the patients had IMH (
T2* <20 msec on
T2* maps). Both T1 and T2 values of the hypointense core within the area‐at‐risk (AAR) performed equally well to detect IMH (T1 maps AUC 0.86 [95% confidence interval [CI] 0.72–0.99] versus T2 maps AUC 0.86 [95% CI 0.74–0.99]; P = 0.94). Using the binary assessment of presence or absence of a hypointense core on the maps, the diagnostic performance of T1 and T2 remained equally good (T1 AUC 0.87 [95% CI 0.73–1.00] versus T2 AUC 0.85 [95% CI 0.71–0.99]; P = 0.90) with good sensitivity and specificity (T1: 88% and 85% and T2: 85% and 85%, respectively). Conclusion The presence of a hypointense core on the T1 and T2 maps can detect IMH equally well and with good sensitivity and specificity in reperfused STEMI patients and could be used as an alternative when
T2* images are not acquired or are not interpretable. Level of Evidence: 2 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;46:877–886
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Affiliation(s)
- Heerajnarain Bulluck
- Hatter Cardiovascular Institute, Institute of Cardiovascular Science University College London, UK.,Barts Heart Centre, St Bartholomew's Hospital, London, UK.,National Heart Research Institute Singapore, National Heart Centre Singapore
| | | | | | - Anish N Bhuva
- Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | | | | | - Esther Gonzalez-Lopez
- Heart Failure and Inherited Cardiac Diseases Unit Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Manuel de Falla, Madrid, Spain
| | - Manish Ramlall
- Hatter Cardiovascular Institute, Institute of Cardiovascular Science University College London, UK.,National Institute of Health Research University College London Hospitals Biomedical Research Centre, UK.,Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Ashraf Hamarneh
- Hatter Cardiovascular Institute, Institute of Cardiovascular Science University College London, UK.,National Institute of Health Research University College London Hospitals Biomedical Research Centre, UK.,Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Alex Sirker
- National Institute of Health Research University College London Hospitals Biomedical Research Centre, UK.,Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Anna S Herrey
- Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | | | - Derek M Yellon
- Hatter Cardiovascular Institute, Institute of Cardiovascular Science University College London, UK.,National Institute of Health Research University College London Hospitals Biomedical Research Centre, UK
| | - James C Moon
- National Institute of Health Research University College London Hospitals Biomedical Research Centre, UK.,Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Derek J Hausenloy
- Hatter Cardiovascular Institute, Institute of Cardiovascular Science University College London, UK.,National Institute of Health Research University College London Hospitals Biomedical Research Centre, UK.,Barts Heart Centre, St Bartholomew's Hospital, London, UK.,Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore.,National Heart Research Institute Singapore, National Heart Centre Singapore
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87
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Dall'Armellina E. From Recognized to Novel Quantitative CMR Biomarkers of LV Recovery: A Paradigm Shift in Acute Myocardial Infarction Imaging. JACC Cardiovasc Imaging 2016; 10:1000-1002. [PMID: 27771397 DOI: 10.1016/j.jcmg.2016.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/07/2016] [Accepted: 07/14/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Erica Dall'Armellina
- Acute Vascular Imaging Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom.
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88
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Ahmed N, Carberry J, Teng V, Carrick D, Berry C. Risk assessment in patients with an acute ST-elevation myocardial infarction. J Comp Eff Res 2016; 5:581-593. [PMID: 27580675 PMCID: PMC5985500 DOI: 10.2217/cer-2016-0017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
ST-elevation myocardial infarction (STEMI) is one of the leading causes of mortality and morbidity worldwide. While the survival after acute STEMI has considerably improved, mortality rate still remains high, especially in high-risk patients. Survival after acute STEMI is influenced by clinical characteristics such as age as well as the presence of comorbidities. However, during emergency care increasing access to tools such as the electrocardiogram, chest x-ray and echocardiography can provide additional information helping to further risk stratify patients. In the invasive setting, this can also include coronary angiography, invasive hemodynamic recordings and angiographic assessments of coronary flow and myocardial perfusion. We outline the common investigations used in STEMI and their role in risk assessment of patients with an acute STEMI.
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Affiliation(s)
- Nadeem Ahmed
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK.,Golden Jubilee National Hospital, Clydebank, UK
| | - Jaclyn Carberry
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK.,Golden Jubilee National Hospital, Clydebank, UK
| | - Vannesa Teng
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK.,Golden Jubilee National Hospital, Clydebank, UK
| | - David Carrick
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK.,Golden Jubilee National Hospital, Clydebank, UK
| | - Colin Berry
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK.,Golden Jubilee National Hospital, Clydebank, UK
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89
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Berry C, Carrick D, Haig C, Oldroyd KG. "Waves of Edema" Seem Implausible. J Am Coll Cardiol 2016; 67:1868-1869. [PMID: 27081030 DOI: 10.1016/j.jacc.2015.11.073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 11/29/2015] [Indexed: 11/17/2022]
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90
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Mangion K, Berry C. Advances in Magnetic Resonance Imaging of the Myocardial Area at Risk and Salvage. Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.116.005127. [PMID: 27412660 DOI: 10.1161/circimaging.116.005127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kenneth Mangion
- From the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank and BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland, UK
| | - Colin Berry
- From the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank and BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland, UK.
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