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Canton L, Suma N, Amicone S, Impellizzeri A, Bodega F, Marinelli V, Ciarlantini M, Casuso M, Bavuso L, Belà R, Salerno J, Armillotta M, Angeli F, Sansonetti A, Attinà D, Russo V, Lovato L, Tuttolomondo D, Gaibazzi N, Bergamaschi L, Pizzi C. Clinical impact of multimodality assessment of myocardial viability. Echocardiography 2024; 41:e15854. [PMID: 38940225 DOI: 10.1111/echo.15854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 05/20/2024] [Indexed: 06/29/2024] Open
Abstract
Coronary artery disease (CAD) is a prevalent cause of left ventricular dysfunction. Nevertheless, effective elective revascularization, particularly surgical revascularization, can enhance long-term outcomes and, in selected cases, global left ventricular contractility. The assessment of myocardial viability and scars is still relevant in guiding treatment decisions and selecting patients who are likely to benefit most from blood flow restoration. Although the most recent randomized studies challenge the notion of "hibernating myocardium" and the clinical usefulness of assessing myocardial viability, the advancement of imaging techniques still renders this assessment valuable in specific situations. According to the guidelines of the European Society of Cardiology, non-invasive stress imaging may be employed to define myocardial ischemia and viability in patients with CAD and heart failure before revascularization. Currently, several non-invasive imaging techniques are available to evaluate the presence and extent of viable myocardium. The selection of the most suitable technique should be based on the patient, clinical context, and resource availability. This narrative review evaluates the characteristics of available imaging modalities for assessing myocardial viability to determine the most appropriate therapeutic strategy.
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Affiliation(s)
- Lisa Canton
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Nicole Suma
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Sara Amicone
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Andrea Impellizzeri
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Francesca Bodega
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Virginia Marinelli
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Mariachiara Ciarlantini
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Marcello Casuso
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Leonardo Bavuso
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Rebecca Belà
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Jessica Salerno
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Matteo Armillotta
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Francesco Angeli
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Angelo Sansonetti
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Domenico Attinà
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Vincenzo Russo
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luigi Lovato
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Nicola Gaibazzi
- Department of Cardiology, Parma University Hospital, Parma, Italy
| | - Luca Bergamaschi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Carmine Pizzi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
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Guglielmo M, Pontone G. Clinical implications of cardiac magnetic resonance imaging fibrosis. Eur Heart J Suppl 2022; 24:I123-I126. [PMID: 36380812 PMCID: PMC9653130 DOI: 10.1093/eurheartjsupp/suac085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
Cardiac magnetic resonance (CMR) is a non-invasive imaging method that allows to characterize myocardial tissue. In particular, using the late gadolinium enhancement technique, it is possible to identify areas of focal fibrosis. Specific distribution patterns of this fibrosis allow us to distinguish ischaemic cardiomyopathy (iCMP) from non-ischaemic cardiomyopathy (nCMP) and sometimes to identify the aetiology of the latter. Diffuse fibrosis can also be identified using the parametric T1 mapping sequences. For this purpose, the native T1 of the tissue is measured before the administration of the contrast agent (c.a.) or the extracellular volume is calculated after c.a. Both focal and diffuse fibrosis evaluated with CMR appear to be strong prognostic predictors for the identification of threatening ventricular arrhythmias and sudden cardiac death. These evidence open the doors to a possible role of CMR in the selection of the patient to be sent to a defibrillator implant in primary prevention. In this review, we will briefly review the techniques used in CMR for the evaluation of fibrosis. We will then focus on the clinical role of myocardial tissue fibrosis detection in iCMP and nCMP.
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Affiliation(s)
- Marco Guglielmo
- Department of Cardiology, Division of Heart and Lungs, Utrecht University, Utrecht University Medical Center, Utrecht, The Netherlands
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Zhang S, Ma Q, Jiao Y, Wu J, Yu T, Hou Y, Sun Z, Zheng L, Sun Z. Prognostic value of myocardial salvage index assessed by cardiovascular magnetic resonance in reperfused ST-segment elevation myocardial infarction. Front Cardiovasc Med 2022; 9:933733. [PMID: 36051284 PMCID: PMC9425200 DOI: 10.3389/fcvm.2022.933733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 07/20/2022] [Indexed: 12/19/2022] Open
Abstract
AimsCardiovascular magnetic resonance (CMR) is a powerful tool to quantify the myocardial area at risk (AAR) and infarct size (IS), and evaluate the extent of myocardial salvage in acute ST-segment elevation myocardial infarction (STEMI). This study aimed to assess the prognostic value of myocardial salvage index (MSI) assessed by CMR in reperfused STEMI and investigate whether MSI could improve the predictive efficacy of the Global Registry of Acute Coronary Events (GRACE) risk score.Methods and results:About 104 consecutive patients who were hospitalized with first-time STEMI and received reperfusion therapy were prospectively enrolled. The primary endpoint was the incident of major adverse cardiovascular event (MACE) including all-cause mortality, non-fatal myocardial reinfarction and congestive heart failure within 36 months after the index event. Cox regression analysis was used to evaluate the prognostic association of MSI with MACE risk. About 21 (20.2%) patients developed MACE during the 3-year follow-up period, and patients with MSI < median had a higher incidence of MACE than those with MSI ≥ median [16 (30.8%) vs. 5 (9.6%), P = 0.007]. After adjusting all the parameters associated with MACE in univariate Cox analysis, MSI assessed by CMR remained independently significant as a predictor of MACE in multivariate Cox analysis (hazard ratio 0.963, 95% CI: 0.943–0.983; P < 0.001). Adding MSI to the GRACE risk score significantly increased the prognostic accuracy of the GRACE risk score (area under the curve: 0.833 vs. 0.773; P = 0.044), with a net reclassification improvement of 0.635 (P = 0.009) and an integrated discrimination improvement of 0.101 (P = 0.002).ConclusionThis study confirmed that MSI assessed by CMR had a good long-term prognostic value in reperfused STEMI and improve the prognostic performance of the GRACE risk score.
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Affiliation(s)
- Shiru Zhang
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Quanmei Ma
- Department of Radiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Radiology, Ganzhou Municipal Hospital, Ganzhou, China
| | - Yundi Jiao
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jiake Wu
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Tongtong Yu
- Department of Cardiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yang Hou
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhijun Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Liqiang Zheng
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Liqiang Zheng,
| | - Zhaoqing Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
- Zhaoqing Sun,
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Image Quality and Reliability of a Novel Dark-Blood Late Gadolinium Enhancement Sequence in Ischemic Cardiomyopathy. J Thorac Imaging 2021; 35:326-333. [PMID: 32845112 DOI: 10.1097/rti.0000000000000448] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE The aim of this study was to assess the reliability of a 2D dark-blood phase-sensitive late gadolinium enhancement sequence (2D-DBPSLGE) compared with 2D phase-sensitive inversion recovery late gadolinium enhancement sequence (2D-BBPSLGE) in patients with ischemic cardiomyopathy (ICM). MATERIALS AND METHODS A total of 73 patients with a clinical history of ICM were prospectively enrolled. The following endpoints were evaluated: (a) comparison of image quality between 2D-BBPSLGE and 2D-DBPSLGE for differentiation between blood pool-late gadolinium enhancement (LGE), remote myocardium-LGE, and blood pool-remote myocardium; (b) diagnostic accuracy of 2D-DBPSLGE compared with gold standard 2D-BBPSLGE for the evaluation of infarcted segments; (c) diagnostic accuracy of 2D-DBPSLGE for the evaluation of microvascular obstruction (MVO); (d) comparison of transmurality index between 2D-BBPSLGE and 2D-DBPSLGE; (e) comparison of papillary muscle hyperenhancement between 2D-BBPSLGE and 2D-DBPSLGE; inter-reader agreement for depiction of hyperenhanced segments in both LGE sequences. Data were analyzed using paired t test, Wilcoxon test, and McNemar test, and η coefficient and intercorrelation coefficient (ICC). RESULTS Image quality was superior for 2D-DBPSLGE for differentiation of blood pool-LGE (P<0.001). 2D-DBPSLGE, compared with 2D-BBPSLGE, showed a sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of 96.93%, 99.89%, 99.71%, 98.78, and 99.04%, respectively. Concerning MVO detection, 2D-DBPSLGE showed a sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of 66.67%, 100.00%, 100.00%, 80.95%, and 86.21%, respectively. 2D-DBPSLGE underestimated the transmurality (P=0.007) and identified papillary muscle hyperenhancement (P<0.001). Both LGE sequences showed comparable interobserver agreement for the evaluation of infarcted areas (2D-BBPSLGE: ICC 0.99;2D-DBPSLGE: ICC 0.99). CONCLUSIONS Compared with 2D-BBPSLGE, 2D-DBPSLGE sequences provide better differentiation between LGE and blood-pool, while underestimating LGE trasmurality and the presence of MVO.
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Topal DG, Aleksov Ahtarovski K, Lønborg J, Høfsten D, Nepper-Christensen L, Kyhl K, Schoos M, Ghotbi AA, Göransson C, Bertelsen L, Holmvang L, Helqvist S, Pedersen F, Schnabel R, Køber L, Kelbæk H, Vejlstrup N, Engstrøm T, Clemmensen P. Impact of age on reperfusion success and long-term prognosis in ST-segment elevation myocardial infarction - A cardiac magnetic resonance imaging study. IJC HEART & VASCULATURE 2021; 33:100731. [PMID: 33732867 PMCID: PMC7937772 DOI: 10.1016/j.ijcha.2021.100731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 01/31/2021] [Indexed: 11/05/2022]
Abstract
Background Coronary collateral circulation and conditioning from
remote ischemic coronary territories may protect culprit myocardium in the
elderly, and younger STEMI patients could suffer from larger infarcts. We
evaluated the impact of age on myocardial salvage and long-term prognosis in a
contemporary STEMI cohort. Methods Of 1603 included STEMI patients 807 underwent cardiac
magnetic resonance. To assess the impact of age on infarct size and left
ventricular ejection fraction (LVEF) as well as the composite endpoint of death
and re-hospitalization for heart failure we stratified the patients by an age
cut-off of 60 years. Results Younger STEMI patients had smaller final infarcts (10%
vs. 12%, P = 0.012) and higher final LVEF (60% vs. 58%, P = 0.042). After
adjusting for multiple potential confounders age did not remain significantly
associated with infarct size and LVEF. During 4-year follow-up, the composite
endpoint occurred less often in the young (3.2% vs. 17.2%; P < 0.001) with a
univariate hazard ratio of 5.77 (95% CI, 3.75–8.89; p < 0.001). Event
estimates of 4 subgroups (young vs. elderly and infarct size beyond vs. below
median) showed a gradual increase in the occurrence of the composite endpoint
depending on both age and acute infarct size (log-rank
p < 0.001). Conclusion Having a STEMI after entering the seventh decade of life
more than quadrupled the risk of future death or re-hospitalization for heart
failure. Risk of death and re-hospitalization depended on both advanced age and
infarct size, albeit no substantial difference was found in infarct size, LVEF
and salvage potential between younger and elderly patients with
STEMI.
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Affiliation(s)
- Divan Gabriel Topal
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | | | - Jacob Lønborg
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Dan Høfsten
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | | | - Kasper Kyhl
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Mikkel Schoos
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Adam Ali Ghotbi
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | | | - Litten Bertelsen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Lene Holmvang
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Steffen Helqvist
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Frants Pedersen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Renate Schnabel
- Department of Cardiology, University Heart Center Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Henning Kelbæk
- Department of Cardiology, Zealand University Hospital, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark.,Department of Cardiology, Lund University Hospital, Lund, Sweden
| | - Peter Clemmensen
- Department of Cardiology, University Heart Center Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.,Department of Medicine, Nykøbing F Hospital, Nykøbing F, Institute for Regional Research, University of Southern Denmark, Odense, Denmark
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Baessato F, Guglielmo M, Muscogiuri G, Baggiano A, Fusini L, Scafuri S, Babbaro M, Mollace R, Collevecchio A, Guaricci AI, Pontone G. Stress CMR in Known or Suspected CAD: Diagnostic and Prognostic Role. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6678029. [PMID: 33511208 PMCID: PMC7822671 DOI: 10.1155/2021/6678029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/23/2020] [Accepted: 01/04/2021] [Indexed: 12/12/2022]
Abstract
The recently published 2019 guidelines on chronic coronary syndromes (CCS) focus on the need for noninvasive imaging modalities to accurately establish the diagnosis of coronary artery disease (CAD) and assess the risk of clinical scenario occurrence. Appropriate patient management should rely on controlling symptoms, improving prognosis, and guiding each therapeutic strategy as well as monitoring disease progress. Among the noninvasive imaging modalities, cardiovascular magnetic resonance (CMR) has gained broad acceptance in past years due to its unique features in providing a complete assessment of CAD through data on cardiac anatomy and function and myocardial viability, with high spatial and temporal resolution and without ionizing radiation. In detail, evaluation of the presence and extent of myocardial ischemia through stress CMR (S-CMR) has shown a high rule-in power in detecting functionally significant coronary artery stenosis in patients suspected of CCS. Moreover, S-CMR technique may add significant prognostic value, as demonstrated by different studies which have progressively evidenced the valuable power of this multiparametric imaging modality in predicting adverse cardiac events. The latest scientific progress supports a greater expansion of S-CMR with improvement of quantitative myocardial perfusion analysis, myocardial strain, and native mapping within the same examination. Although further study is warranted, these techniques, which are currently mostly restricted to the research field, are likely to become increasingly prevalent in the clinical setting with the scope of increasing accuracy in the selection of patients to be sent to invasive revascularization. This review investigates the diagnostic and prognostic role of S-CMR in the context of CAD, by analysing a strong, long-standing, scientific evidence together with an appraisal of new advanced techniques which may potentially enrich CAD management in the next future.
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Affiliation(s)
- Francesca Baessato
- Department of Cardiology, San Maurizio Regional Hospital, Bolzano, Italy
| | - Marco Guglielmo
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Giuseppe Muscogiuri
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Andrea Baggiano
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Laura Fusini
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Stefano Scafuri
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Mario Babbaro
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Rocco Mollace
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Ada Collevecchio
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Andrea I. Guaricci
- Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy
| | - Gianluca Pontone
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
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Broncano J, Bhalla S, Caro P, Hidalgo A, Vargas D, Williamson E, Gutiérrez F, Luna A. Cardiac MRI in Patients with Acute Chest Pain. Radiographics 2020; 41:8-31. [PMID: 33337967 DOI: 10.1148/rg.2021200084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Acute chest pain is a common reason for visits to the emergency department. It is important to distinguish among the various causes of acute chest pain, because treatment and prognosis are substantially different among the various conditions. It is critical to exclude acute coronary syndrome (ACS), which is a major cause of hospitalization, death, and health care costs worldwide. Myocardial ischemia is defined as potential myocyte death secondary to an imbalance between oxygen supply and demand due to obstruction of an epicardial coronary artery. Unobstructed coronary artery disease can have cardiac causes (eg, myocarditis, myocardial infarction with nonobstructed coronary arteries, and Takotsubo cardiomyopathy), and noncardiac diseases can manifest with acute chest pain and increased serum cardiac biomarker levels. In the emergency department, cardiac MRI may aid in the identification of patients with non-ST-segment elevation myocardial infarction or unstable angina or ACS with unobstructed coronary artery disease, if the patient's clinical history is known to be atypical. Also, cardiac MRI is excellent for risk stratification of patients for adverse left ventricular remodeling or major adverse cardiac events. Cardiac MRI should be performed early in the course of the disease (<2 weeks after onset of symptoms). Steady-state free-precession T2-weighted MRI with late gadolinium enhancement is the mainstay of the cardiac MRI protocol. Further sequences can be used to analyze the different pathophysiologic subjacent mechanisms of the disease, such as microvascular obstruction or intramyocardial hemorrhage. Finally, cardiac MRI may provide several prognostic biomarkers that help in follow-up of these patients. Online supplemental material is available for this article. ©RSNA, 2020.
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Affiliation(s)
- Jordi Broncano
- From the Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESSALTA, HT Médica, Avenida el Brillante, number 36, 14012, Córdoba, Spain (J.B.); Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., F.G.); Department of Radiology, HT-DADISA, HT Médica, Cádiz, Spain (P.C.); Radiology Unit, Hospital Santa Creu i Sant Pau, Barcelona, Spain (A.H.); Department of Radiology, University of Colorado-Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.W.); and MRI Section, Department of Radiology, Clínica las Nieves, HT-SERCOSA, HT Médica, Jaén, Spain (A.L.)
| | - Sanjeev Bhalla
- From the Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESSALTA, HT Médica, Avenida el Brillante, number 36, 14012, Córdoba, Spain (J.B.); Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., F.G.); Department of Radiology, HT-DADISA, HT Médica, Cádiz, Spain (P.C.); Radiology Unit, Hospital Santa Creu i Sant Pau, Barcelona, Spain (A.H.); Department of Radiology, University of Colorado-Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.W.); and MRI Section, Department of Radiology, Clínica las Nieves, HT-SERCOSA, HT Médica, Jaén, Spain (A.L.)
| | - Pilar Caro
- From the Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESSALTA, HT Médica, Avenida el Brillante, number 36, 14012, Córdoba, Spain (J.B.); Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., F.G.); Department of Radiology, HT-DADISA, HT Médica, Cádiz, Spain (P.C.); Radiology Unit, Hospital Santa Creu i Sant Pau, Barcelona, Spain (A.H.); Department of Radiology, University of Colorado-Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.W.); and MRI Section, Department of Radiology, Clínica las Nieves, HT-SERCOSA, HT Médica, Jaén, Spain (A.L.)
| | - Alberto Hidalgo
- From the Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESSALTA, HT Médica, Avenida el Brillante, number 36, 14012, Córdoba, Spain (J.B.); Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., F.G.); Department of Radiology, HT-DADISA, HT Médica, Cádiz, Spain (P.C.); Radiology Unit, Hospital Santa Creu i Sant Pau, Barcelona, Spain (A.H.); Department of Radiology, University of Colorado-Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.W.); and MRI Section, Department of Radiology, Clínica las Nieves, HT-SERCOSA, HT Médica, Jaén, Spain (A.L.)
| | - Daniel Vargas
- From the Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESSALTA, HT Médica, Avenida el Brillante, number 36, 14012, Córdoba, Spain (J.B.); Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., F.G.); Department of Radiology, HT-DADISA, HT Médica, Cádiz, Spain (P.C.); Radiology Unit, Hospital Santa Creu i Sant Pau, Barcelona, Spain (A.H.); Department of Radiology, University of Colorado-Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.W.); and MRI Section, Department of Radiology, Clínica las Nieves, HT-SERCOSA, HT Médica, Jaén, Spain (A.L.)
| | - Eric Williamson
- From the Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESSALTA, HT Médica, Avenida el Brillante, number 36, 14012, Córdoba, Spain (J.B.); Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., F.G.); Department of Radiology, HT-DADISA, HT Médica, Cádiz, Spain (P.C.); Radiology Unit, Hospital Santa Creu i Sant Pau, Barcelona, Spain (A.H.); Department of Radiology, University of Colorado-Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.W.); and MRI Section, Department of Radiology, Clínica las Nieves, HT-SERCOSA, HT Médica, Jaén, Spain (A.L.)
| | - Fernando Gutiérrez
- From the Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESSALTA, HT Médica, Avenida el Brillante, number 36, 14012, Córdoba, Spain (J.B.); Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., F.G.); Department of Radiology, HT-DADISA, HT Médica, Cádiz, Spain (P.C.); Radiology Unit, Hospital Santa Creu i Sant Pau, Barcelona, Spain (A.H.); Department of Radiology, University of Colorado-Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.W.); and MRI Section, Department of Radiology, Clínica las Nieves, HT-SERCOSA, HT Médica, Jaén, Spain (A.L.)
| | - Antonio Luna
- From the Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESSALTA, HT Médica, Avenida el Brillante, number 36, 14012, Córdoba, Spain (J.B.); Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., F.G.); Department of Radiology, HT-DADISA, HT Médica, Cádiz, Spain (P.C.); Radiology Unit, Hospital Santa Creu i Sant Pau, Barcelona, Spain (A.H.); Department of Radiology, University of Colorado-Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.W.); and MRI Section, Department of Radiology, Clínica las Nieves, HT-SERCOSA, HT Médica, Jaén, Spain (A.L.)
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Intracoronary compared with intravenous bolus tirofiban on the microvascular obstruction in patients with STEMI undergoing PCI: a cardiac MR study. Int J Cardiovasc Imaging 2020; 36:1121-1132. [PMID: 32078096 DOI: 10.1007/s10554-020-01800-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 02/16/2020] [Indexed: 01/03/2023]
Abstract
To investigate the potential effect of intracoronary administration of the glycoprotein IIb/IIIa inhibitor tirofiban on the microvascular obstruction (MVO) assessed by cardiac magnetic resonance (CMR) imaging compared to the intravenous route in patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI). Two hundred eight patients were randomized into two groups (tirofiban i.v. and tirofiban i.c.). CMR was completed within 3-7 days after ST-segment-elevation myocardial infarction. One hundred thirty-two patients had a follow-up CMR at 6 months after discharge. The primary end point was the CMR measurements including myocardium strain, myocardial perfusion index, final infarct size, prevalence and extent of MVO, and the change of left ventricular end-diastolic volume (LVEDV) at six months follow-up. The second endpoint was major adverse cardiovascular events (composite of all-cause death, nonfatal reinfarction and congestive heart failure) in one year. The MVO prevalence and extent [56% versus 36%, p = 0.004; 2.08 (IQR: 1.18-5.07) g versus 1.68 (IQR: 0.30-3.28) g, p = 0.041] showed a significant difference between the intravenous and intracoronary groups. Global left ventricular peak longitudinal strain was significantly different in intracoronary groups compared to intravenous groups, - 12.5 [IQR: - 13.4 to - 10.9] versus - 12.3 [IQR: - 13.4 to - 10.4], respectively (P = 0.042). Infarcted myocardial perfusion index was significantly different in intracoronary groups compared to intravenous groups, 0.11 [IQR: 0.08 to 0.15] versus 0.09 [IQR: 0.07 to 0.14], respectively (P = 0.026). Intracoronary tirofiban was associated with a higher change in LVEDV compared with intravenous group (- 10.2% [IQR: - 13.7% to - 2.6%] versus 1.3% [IQR: - 5.6% to 6.1%], p < 0.001). Intracoronary tirofiban application showed no benefit on the occurrence of major adverse cardiovascular events during follow-up compared to intravenous administration. This CMR study in ST-segment-elevation myocardial infarction patients showed a benefit in MVO and left ventricular remodeling for intracoronary tirofiban administration compared to intravenous administration in patients undergoing PCI.
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Future perspectives of nanoparticle-based contrast agents for cardiac magnetic resonance in myocardial infarction. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2019; 17:329-341. [PMID: 30802547 DOI: 10.1016/j.nano.2019.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 01/11/2019] [Accepted: 02/02/2019] [Indexed: 12/23/2022]
Abstract
Cardiac Magnetic Resonance (CMR), thanks to high spatial resolution and absence of ionizing radiation, has been widely used in myocardial infarction (MI) assessment to evaluate cardiac structure, function, perfusion and viability. Nevertheless, it suffers from limitations in tissue and assessment of myocardial pathophysiological changes subsequent to MI. In this issue, nanoparticle-based contrast agents offer the possibility to track biological processes at cellular and molecular level underlying the various phases of MI, infarct healing and tissue repair. In this paper, first we examine the conventional CMR protocol and its findings in MI patients. Next, we looked at how nanoparticles can help in the imaging of MI and give an overview of the major approaches currently explored. Based on the presentation of successful nanoparticle applications as contrast agents (CAs) in preclinical and clinical models, we discuss promises and outstanding challenges facing the field of CMR in MI, their translational potential and clinical application.
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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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