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Aquaro GD, Di Paolo M, Guidi B, Ghabisonia K, Pucci A, Aringheri G, Gorgodze N, Veronica M, Chiti E, Burchielli S, Turillazzi E, Emdin M, Caramella D, Recchia FA. Post-mortem CMR in a model of sudden death due to myocardial ischemia: validation with connexin-43. Eur Radiol 2021; 31:8098-8107. [PMID: 33876299 DOI: 10.1007/s00330-021-07890-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 03/08/2021] [Accepted: 03/15/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES We sought to evaluate the effectiveness of post-mortem cardiac magnetic resonance (PM-CMR) for the identification of myocardial ischemia as cause of sudden cardiac death (SCD) when the time interval between the onset of ischemia and SCD is ≤ 90 min. METHODS PM-CMR was performed in 8 hearts explanted from pigs with spontaneous death caused by occlusion of the left anterior descending coronary artery: 4 with SCD after ≤ 40 min of coronary occlusion and 4 between 40 and 90 min. PM-CMR included conventional T1 and T2-weighted image and T1, T2, and T2* mapping techniques. Imaging data were compared and validated with immunohistochemical evaluation of the altered proportion and redistribution of phosphorylated versus non-phosphorylated connexin 43 (CX43 and npCX43, respectively), an established molecular marker of myocardial ischemia. RESULTS At T2-weighted images, the ischemic core was hypointense (core/remote ratio 0.67 ± 0.11) and surrounded by and hyperintense border zone. Compared to remote myocardium, the ischemic core had higher T1 (p = 0.0008), and lower T2 (p = 0.007) and T2* (p = 0.002). Cytoplasmatic npX43 and the npCX43/CX43 ratio were significantly higher in animals deceased > 40 min than in others. CONCLUSION PM-CMR can reliably detect early signs of myocardial damage induced by ischemia, based on conventional pulse sequences complemented by a novel ad hoc application of quantitative mapping techniques. KEY POINTS • Post-mortem MRI may help to understand cause of sudden cardiac death. • Post-mortem MRI allows detection of signs of myocardial ischemia as cause of sudden cardiac death within 90 and 40 min following coronary occlusion as demonstrated in a pig model of myocardial ischemia. • Signs of myocardial ischemia using conventional and mapping MRI technique are associated with the immunohistochemical changes of phosphorylated and dephosphorylated connexin-43 which is an established molecular marker of myocardial ischemia.
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Affiliation(s)
| | | | - Benedetta Guidi
- Clinical and Translational Science Research Department, University of Pisa, Pisa, Italy
| | | | - Angela Pucci
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Giacomo Aringheri
- Clinical and Translational Science Research Department, University of Pisa, Pisa, Italy
| | - Nikoloz Gorgodze
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Musetti Veronica
- Clinical and Translational Science Research Department, University of Pisa, Pisa, Italy
| | - Enrica Chiti
- Clinical and Translational Science Research Department, University of Pisa, Pisa, Italy
| | - Silvia Burchielli
- Fondazione Toscana G. Monasterio, Via Giuseppe Moruzzi, 1, 56124, Pisa, Italy
| | | | - Michele Emdin
- Fondazione Toscana G. Monasterio, Via Giuseppe Moruzzi, 1, 56124, Pisa, Italy.,Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Davide Caramella
- Clinical and Translational Science Research Department, University of Pisa, Pisa, Italy
| | - Fabio A Recchia
- Fondazione Toscana G. Monasterio, Via Giuseppe Moruzzi, 1, 56124, Pisa, Italy.,Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
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