1
|
Pei Z, Qiu J, Zhao Y, Song S, Wang R, Luo W, Cai X, Liu B, Chen H, Yin J, Weng X, Wu Y, Li C, Shen L, Ge J. A novel intracoronary hypothermia device reduces myocardial reperfusion injury in pigs. Chin Med J (Engl) 2024:00029330-990000000-00988. [PMID: 38445387 DOI: 10.1097/cm9.0000000000003033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Hypothermia therapy has been suggested to attenuate myocardial necrosis; however, the clinical implementation as a valid therapeutic strategy has failed, and new approaches are needed to translate into clinical applications. This study aimed to assess the feasibility, safety, and efficacy of a novel selective intracoronary hypothermia (SICH) device in mitigating myocardial reperfusion injury. METHODS This study comprised two phases. The first phase of the SICH was performed in a normal porcine model for 30 minutes ( n = 5) to evaluate its feasibility. The second phase was conducted in a porcine myocardial infarction (MI) model of myocardial ischemia/reperfusion was performed by balloon occlusion of the left anterior descending coronary artery for 60 minutes and maintained for 42 days. Pigs in the hypothermia group ( n = 8) received hypothermia intervention onset reperfusion for 30 minutes and controls ( n = 8) received no intervention. All animals were followed for 42 days. Cardiac magnetic resonance analysis (5 and 42 days post-MI) and a series of biomarkers/histological studies were performed. RESULTS The average time to lower temperatures to a steady state was 4.8 ± 0.8 s. SICH had no impact on blood pressure or heart rate and was safely performed without complications by using a 3.9 F catheter. Interleukin-6 (IL-6), tumor necrosis factor-α, C-reactive protein (CRP), and brain natriuretic peptide (BNP) were lower at 60 min post perfusion in pigs that underwent SICH as compared with the control group. On day 5 post MI/R, edema, intramyocardial hemorrhage, and microvascular obstruction were reduced in the hypothermia group. On day 42 post MI/R, the infarct size, IL-6, CRP, BNP, and matrix metalloproteinase-9 were reduced, and the ejection fraction was improved in pigs that underwent SICH. CONCLUSIONS The SICH device safely and effectively reduced the infarct size and improved heart function in a pig model of MI/R. These beneficial effects indicate the clinical potential of SICH for treatment of myocardial reperfusion injury.
Collapse
Affiliation(s)
- Zhiqiang Pei
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
| | - Jin Qiu
- Department of Cardiology, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, Shanxi 030009, China
| | - Yongchao Zhao
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, China
| | - Shuai Song
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
- National Clinical Research for Interventional Medicine, Shanghai 200032, China
| | - Rui Wang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
- National Clinical Research for Interventional Medicine, Shanghai 200032, China
| | - Wei Luo
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
- National Clinical Research for Interventional Medicine, Shanghai 200032, China
| | - Xingxing Cai
- Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 201322, China
| | - Bin Liu
- Department of Cardiology, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, Shanxi 030009, China
| | - Han Chen
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
- National Clinical Research for Interventional Medicine, Shanghai 200032, China
| | - Jiasheng Yin
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
- National Clinical Research for Interventional Medicine, Shanghai 200032, China
| | - Xinyu Weng
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- National Clinical Research for Interventional Medicine, Shanghai 200032, China
| | - Yizhe Wu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- National Clinical Research for Interventional Medicine, Shanghai 200032, China
| | - Chenguang Li
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- National Clinical Research for Interventional Medicine, Shanghai 200032, China
| | - Li Shen
- National Clinical Research for Interventional Medicine, Shanghai 200032, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
| |
Collapse
|
2
|
Abstract
Major advances in biomedical imaging have occurred over the last 2 decades and now allow many physiological, cellular, and molecular processes to be imaged noninvasively in small animal models of cardiovascular disease. Many of these techniques can be also used in humans, providing pathophysiological context and helping to define the clinical relevance of the model. Ultrasound remains the most widely used approach, and dedicated high-frequency systems can obtain extremely detailed images in mice. Likewise, dedicated small animal tomographic systems have been developed for magnetic resonance, positron emission tomography, fluorescence imaging, and computed tomography in mice. In this article, we review the use of ultrasound and positron emission tomography in small animal models, as well as emerging contrast mechanisms in magnetic resonance such as diffusion tensor imaging, hyperpolarized magnetic resonance, chemical exchange saturation transfer imaging, magnetic resonance elastography and strain, arterial spin labeling, and molecular imaging.
Collapse
Affiliation(s)
- David E Sosnovik
- Cardiology Division, Cardiovascular Research Center (D.E.S.), Massachusetts General Hospital and Harvard Medical School, Boston.,A.A. Martinos Center for Biomedical Imaging (D.E.S.), Massachusetts General Hospital and Harvard Medical School, Boston.,Harvard-MIT Program in Health Sciences and Technology, Harvard Medical School and Massachusetts Institute of Technology, Cambridge (D.E.S.)
| | - Marielle Scherrer-Crosbie
- Cardiology Division, Hospital of the University of Pennsylvania and Perelman School of Medicine, Philadelphia (M.S.-C)
| |
Collapse
|
3
|
Thomas R, Thai K, Barry J, Wright GA, Strauss BH, Ghugre NR. T2-based area-at-risk and edema are influenced by ischemic duration in acute myocardial infarction. Magn Reson Imaging 2021; 79:1-4. [PMID: 33652063 DOI: 10.1016/j.mri.2021.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/13/2021] [Accepted: 02/25/2021] [Indexed: 10/22/2022]
Abstract
The purpose of our study was to assess whether T2 MRI identifies the infarcted myocardium or the true area-at-risk (AAR) and whether edema is present in the salvageable region following acute myocardial infarction (MI). The study involved a porcine model of MI with a coronary occlusion model of either 60 min or 90 min. Imaging was performed on a 3T MRI pre-occlusion and at day 3 post-MI. Prior-MI, myocardial perfusion territory (MPT) maps were obtained under MRI via direct intracoronary injection of contrast agent. Post-MI, edema extent was quantified by T2 mapping while infarction and microvascular obstruction (MVO) were assessed by late gadolinium enhancement (LGE). Anatomically registered short-axis slices were analyzed for MPT, T2-AAR and infarct areas and T2 relaxation values. Animals were divided into groups with (MVO+) and without MVO (MVO-). T2-AAR area was significantly greater than infarct area in both groups. In the MVO+ group, T2-AAR and MPT were comparable and highly correlated, whereas, in the MVO- group, T2-AAR significantly underestimated MPT without any trend. T2 values in the salvageable myocardium were found to be significantly higher than those in remote myocardium. Our methodology offers the advantage that all images are acquired within the same MRI reference as opposed to complex co-registration with gross pathology. Our study suggests that edema may expand beyond the infarct zone over the entire ischemic bed. T2-AAR may be more clinically relevant than true AAR by perfusion territory since it identifies the "salvageable" myocardium.
Collapse
Affiliation(s)
- Reuben Thomas
- Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Kevin Thai
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Jennifer Barry
- Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Graham A Wright
- Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, Canada; Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Bradley H Strauss
- Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Nilesh R Ghugre
- Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, Canada; Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
4
|
Tiller C, Holzknecht M, Reindl M, Lechner I, Kalles V, Troger F, Schwaiger J, Mayr A, Klug G, Brenner C, Bauer A, Metzler B, Reinstadler SJ. Estimating the extent of myocardial damage in patients with STEMI using the DETERMINE score. Open Heart 2021; 8:openhrt-2020-001538. [PMID: 33547223 PMCID: PMC7871339 DOI: 10.1136/openhrt-2020-001538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/15/2021] [Accepted: 01/18/2021] [Indexed: 11/24/2022] Open
Abstract
Background Recently, a simple ECG score (DETERMINE score) has been proposed for estimating myocardial scar in patients with ischaemic cardiomyopathy. We sought to evaluate the usefulness of the DETERMINE score for the assessment of myocardial infarct size (IS) as well as microvascular obstruction (MVO), in the setting of ST-elevation myocardial infarction (STEMI). Methods This observational study enrolled 423 patients with STEMI (median age 56, 17% women), revascularised by primary percutaneous coronary intervention (PCI). For evaluation of the DETERMINE and Selvester scoring system (an established but complex ECG score for IS estimation), ECG was conducted before discharge (median: 4 (IQR 2–6) days). Cardiac magnetic resonance (CMR) was conducted within a week after infarction for determination of IS and MVO. Results Median DETERMINE score of the overall cohort was 8 points (IQR 5–11). A higher DETERMINE score was significantly associated with a larger IS (21% vs 11% of left ventricular myocardial mass (LVMM), p<0.001) as well as larger MVO (1.2% vs 0.0% of LVMM, p<0.001). In linear and binary multivariable logistic regression analysis, the DETERMINE score remained independently associated with IS (OR 1.09, 95% CI 1.02 to 1.17, p=0.014) and MVO (OR 1.12, 95% CI 1.04 to 1.21, p=0.003), after adjustment for Selvester score and clinical indicators of IS (high-sensitivity cardiac troponin T, high-sensitivity C reactive protein, N-terminal pro-B-type natriuretic peptide, TIMI flow pre-interventional and post-interventional PCI, anterior infarct localisation). Conclusions In patients undergoing PCI for STEMI, the DETERMINE score provides an easy and inexpensive tool for appropriate estimation of infarct severity as determined by CMR.
Collapse
Affiliation(s)
- Christina Tiller
- University Clinic of Internal Medicine III, Cardiology, Medical University of Innsbruck, Innsbruck, Tirol, Austria
| | - Magdalena Holzknecht
- University Clinic of Internal Medicine III, Cardiology, Medical University of Innsbruck, Innsbruck, Tirol, Austria
| | - Martin Reindl
- University Clinic of Internal Medicine III, Cardiology, Medical University of Innsbruck, Innsbruck, Tirol, Austria
| | - Ivan Lechner
- University Clinic of Internal Medicine III, Cardiology, Medical University of Innsbruck, Innsbruck, Tirol, Austria
| | - Verena Kalles
- University Clinic of Internal Medicine III, Cardiology, Medical University of Innsbruck, Innsbruck, Tirol, Austria
| | - Felix Troger
- Department of Radiology I, Medical University of Innsbruck, Innsbruck, Tirol, Austria
| | - Johannes Schwaiger
- Department of Internal Medicine, Academic Teaching Hospital Hall in Tirol, Hall in Tirol, Austria
| | - Agnes Mayr
- Department of Radiology I, Medical University of Innsbruck, Innsbruck, Tirol, Austria
| | - Gert Klug
- University Clinic of Internal Medicine III, Cardiology, Medical University of Innsbruck, Innsbruck, Tirol, Austria
| | - Christoph Brenner
- University Clinic of Internal Medicine III, Cardiology, Medical University of Innsbruck, Innsbruck, Tirol, Austria
| | - Axel Bauer
- University Clinic of Internal Medicine III, Cardiology, Medical University of Innsbruck, Innsbruck, Tirol, Austria
| | - Bernhard Metzler
- University Clinic of Internal Medicine III, Cardiology, Medical University of Innsbruck, Innsbruck, Tirol, Austria
| | | |
Collapse
|
5
|
Reindl M, Eitel I, Reinstadler SJ. Role of Cardiac Magnetic Resonance to Improve Risk Prediction Following Acute ST-Elevation Myocardial Infarction. J Clin Med 2020; 9:E1041. [PMID: 32272692 PMCID: PMC7231095 DOI: 10.3390/jcm9041041] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/01/2020] [Accepted: 04/01/2020] [Indexed: 12/13/2022] Open
Abstract
Cardiac magnetic resonance (CMR) imaging allows comprehensive assessment of myocardial function and tissue characterization in a single examination after acute ST-elevation myocardial infarction. Markers of myocardial infarct severity determined by CMR imaging, especially infarct size and microvascular obstruction, strongly predict recurrent cardiovascular events and mortality. The prognostic information provided by a comprehensive CMR analysis is incremental to conventional risk factors including left ventricular ejection fraction. As such, CMR parameters of myocardial tissue damage are increasingly recognized for optimized risk stratification to further ameliorate the burden of recurrent cardiovascular events in this population. In this review, we provide an overview of the current impact of CMR imaging on optimized risk assessment soon after acute ST-elevation myocardial infarction.
Collapse
Affiliation(s)
- Martin Reindl
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria;
| | - Ingo Eitel
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Ratzeburger Allee 160, D-23538 Lübeck, Germany;
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, D-23538 Lübeck, Germany
| | - Sebastian Johannes Reinstadler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria;
| |
Collapse
|
6
|
Behrouzi B, Weyers JJ, Qi X, Barry J, Rabadia V, Manca D, Connelly J, Spino M, Wood JC, Strauss BH, Wright GA, Ghugre NR. Action of iron chelator on intramyocardial hemorrhage and cardiac remodeling following acute myocardial infarction. Basic Res Cardiol 2020; 115:24. [PMID: 32140789 DOI: 10.1007/s00395-020-0782-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 02/17/2020] [Indexed: 12/22/2022]
Abstract
Intramyocardial hemorrhage is an independent predictor of adverse outcomes in ST-segment elevation myocardial infarction (STEMI). Iron deposition resulting from ischemia-reperfusion injury (I/R) is pro-inflammatory and has been associated with adverse remodeling. The role of iron chelation in hemorrhagic acute myocardial infarction (AMI) has never been explored. The purpose of this study was to investigate the cardioprotection offered by the iron-chelating agent deferiprone (DFP) in a porcine AMI model by evaluating hemorrhage neutralization and subsequent cardiac remodeling. Two groups of animals underwent a reperfused AMI procedure: control and DFP treated (N = 7 each). A comprehensive MRI examination was performed in healthy state and up to week 4 post-AMI, followed by histological assessment. Infarct size was not significantly different between the two groups; however, the DFP group demonstrated earlier resolution of hemorrhage (by T2* imaging) and edema (by T2 imaging). Additionally, ventricular enlargement and myocardial hypertrophy (wall thickness and mass) were significantly smaller with DFP, suggesting reduced adverse remodeling, compared to control. The histologic results were consistent with the MRI findings. To date, there is no effective targeted therapy for reperfusion hemorrhage. Our proof-of-concept study is the first to identify hemorrhage-derived iron as a therapeutic target in I/R and exploit the cardioprotective properties of an iron-chelating drug candidate in the setting of AMI. Iron chelation could potentially serve as an adjunctive therapy in hemorrhagic AMI.
Collapse
Affiliation(s)
- Bita Behrouzi
- Department of Physics and Physiology, University of Toronto, Toronto, ON, Canada
| | - Jill J Weyers
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Xiuling Qi
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Jennifer Barry
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, Canada
| | | | | | | | - Michael Spino
- ApoPharma Inc, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - John C Wood
- Childrens Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA
| | - Bradley H Strauss
- Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Graham A Wright
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, Canada.,Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Nilesh R Ghugre
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, Canada. .,Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. .,Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
7
|
Krumm P, Martirosian P, Rath D, Gawaz M, Nikolaou K, Klumpp BD, Hornung A, Kramer U, Schick F, Geisler T, Zitzelsberger T. Performance of two Methods for Cardiac MRI Edema Mapping: Dual-Contrast Fast Spin-Echo and T2 Prepared Balanced Steady State Free Precession. ROFO-FORTSCHR RONTG 2020; 192:669-677. [PMID: 32018303 DOI: 10.1055/a-1088-3478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE To compare true positive and false negative results of myocardial edema mapping in two methods. Myocardial edema may be difficult to detect on cardiac MRI. MATERIALS AND METHODS 76 patients (age 59 ± 11 years, 15 female) with acute myocardial infarction (MI) and 10 healthy volunteers were prospectively included in this single-center study. 1.5 T cardiac MRI was performed in patients 2.5 days after revascularization (median) for edema mapping: Steady State Free Precession (SSFP) mapping sequence with T2-preparation pulses (T2prep); and dual-contrast Fast Spin-Echo (dcFSE) signal decay edema mapping. Late gadolinium enhancement (LGE) was used as the reference for expected edema in acute MI. RESULTS 311 myocardial segments in patients were acutely infarcted with mean T2 73 ms for T2prep SSFP vs. 87 ms for dcFSE edema mapping. In healthy volunteers the mean T2 was 56 ms for T2prep SSFP vs. 50 ms for dcFSE edema mapping. Receiver operating characteristic (ROC) curve for T2prep SSFP show area under the curve (AUC) 0.962, p < 0.0001, Youden index J 0.8266, associated criterion > 60 ms, sensitivity 94 %, specificity 89 %. dcFSE ROC AUC 0.979, p < 0.0001, J 0.9219, associated criterion > 64 ms, sensitivity 93 %, specificity 99 %. CONCLUSION Both edema mapping methods indicate high-grade edema with high sensitivity. Nevertheless, edema in acute infarction may be focally underestimated in both mapping methods. KEY POINTS · Sensitivity for edema detection is high for both methods.. · Edema may be focally underestimated by T2prep SSFP edema mapping and dcFSE mapping.. CITATION FORMAT · Krumm P, Martirosian P, Rath D et al. Performance of two Methods for Cardiac MRI Edema Mapping: Dual-Contrast Fast Spin-Echo and T2 Prepared Balanced Steady State Free Precession. Fortschr Röntgenstr 2020; 192: 669 - 677.
Collapse
Affiliation(s)
- Patrick Krumm
- Diagnostic and Interventional Radiology, University of Tübingen, Germany
| | | | - Dominik Rath
- Cardiology and Cardiovascular Medicine, University of Tübingen, Germany
| | - Meinrad Gawaz
- Cardiology and Cardiovascular Medicine, University of Tübingen, Germany
| | | | | | | | - Ulrich Kramer
- Diagnostic and Interventional Radiology, University of Tübingen, Germany
| | - Fritz Schick
- Section on Experimental Radiology, University of Tübingen, Germany
| | - Tobias Geisler
- Cardiology and Cardiovascular Medicine, University of Tübingen, Germany
| | | |
Collapse
|
8
|
Mathbout M, Asfour A, Leung S, Lolay G, Idris A, Abdel-Latif A, Ziada KM. NT-proBNP Level Predicts Extent of Myonecrosis and Clinical Adverse Outcomes in Patients with ST-Elevation Myocardial Infarction: A Pilot Study. MEDICAL RESEARCH ARCHIVES 2020; 8:10.18103/mra.v8i2.2039. [PMID: 33094161 PMCID: PMC7575211 DOI: 10.18103/mra.v8i2.2039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND HYPOTHESIS The initial assessment of late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR) reflects cardiac damage and is an important prognostic factor in patients with acute ST-elevation myocardial infarction (STEMI). N-Terminal prohormone of brain natriuretic peptide (NT-proBNP) is released following cardiomyocytes injury. However, the relationship between NT-proBNP levels, myocardial damage and clinical outcomes after STEMI has not been well defined. METHODS Plasma levels of NT-proBNP, troponin I and creatinine kinase (CK) were assessed in 75 patients with STEMI. Echocardiography and CMR were performed prior to hospital discharge. Cardiac damage was quantified using peak biomarker levels and LGE. Patients were followed for a median of 975 days (IQR 823-1098 days) for major adverse cardiac events (MACE) (all-cause mortality, recurrent myocardial infraction, unplanned recurrent revascularization and recurrent hospitalization for heart failure). RESULTS Plasma levels of NT-proBNP increased following STEMI to peak at 24 hours. The dynamic changes in plasma NT-proBNP were similar to those noted with troponin I and its delayed peak but not those observed with plasma CK levels. Peak NT-proBNP levels correlated positively with indices of myocardial damage such as peak troponin I (R2 =0.38, P <0.001), peak CK (R2 =0.22, P = 0.01) and LGE examination (R2 = 0.46, P <0.001). Peak plasma level of NT- proBNP was strongly predictive of MACE during the follow-up period. CONCLUSIONS Peak levels of NT-proBNP following STEMI are predictive of the extent of myocardial damage and clinical outcomes. These results suggest an important prognostic role for NT-proBNP assessment in STEMI patients.
Collapse
Affiliation(s)
- Mohammad Mathbout
- Division of Cardiovascular Medicine, Gill Heart & Vascular Institute, University of Kentucky, and Lexington VA Medical Center, Lexington, KY, USA
| | - Ahmed Asfour
- Division of Cardiovascular Medicine, Gill Heart & Vascular Institute, University of Kentucky, and Lexington VA Medical Center, Lexington, KY, USA
- Department of Cardiology, Cairo University, Cairo, Egypt
| | - Steve Leung
- Division of Cardiovascular Medicine, Gill Heart & Vascular Institute, University of Kentucky, and Lexington VA Medical Center, Lexington, KY, USA
| | - Georges Lolay
- Division of Cardiovascular Medicine, Gill Heart & Vascular Institute, University of Kentucky, and Lexington VA Medical Center, Lexington, KY, USA
| | - Amr Idris
- Division of Cardiovascular Medicine, Gill Heart & Vascular Institute, University of Kentucky, and Lexington VA Medical Center, Lexington, KY, USA
| | - Ahmed Abdel-Latif
- Division of Cardiovascular Medicine, Gill Heart & Vascular Institute, University of Kentucky, and Lexington VA Medical Center, Lexington, KY, USA
| | - Khaled M Ziada
- Division of Cardiovascular Medicine, Gill Heart & Vascular Institute, University of Kentucky, and Lexington VA Medical Center, Lexington, KY, USA
| |
Collapse
|
9
|
Reindl M, Holzknecht M, Tiller C, Lechner I, Schiestl M, Simma F, Pamminger M, Henninger B, Mayr A, Klug G, Bauer A, Metzler B, Reinstadler SJ. Impact of infarct location and size on clinical outcome after ST-elevation myocardial infarction treated by primary percutaneous coronary intervention. Int J Cardiol 2020; 301:14-20. [DOI: 10.1016/j.ijcard.2019.11.123] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/01/2019] [Accepted: 11/15/2019] [Indexed: 11/30/2022]
|
10
|
Tiller C, Reindl M, Reinstadler SJ, Holzknecht M, Schreinlechner M, Peherstorfer A, Hein N, Lechner I, Mayr A, Klug G, Metzler B. Complete versus simplified Selvester QRS score for infarct severity assessment in ST-elevation myocardial infarction. BMC Cardiovasc Disord 2019; 19:285. [PMID: 31815614 PMCID: PMC6902546 DOI: 10.1186/s12872-019-1230-0] [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] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 10/21/2019] [Indexed: 01/14/2023] Open
Abstract
Background Complete and simplified Selvester QRS score have been proposed as valuable clinical tool for estimating myocardial damage in patients with ST-elevation myocardial infarction (STEMI). We sought to comprehensively compare both scoring systems for the prediction of myocardial and microvascular injury assessed by cardiac magnetic resonance (CMR) imaging in patients with acute STEMI. Methods In this prospective observational study, 201 revascularized STEMI patients were included. Electrocardiography was conducted at a median of 2 (interquartile range 1–4) days after the index event to evaluate the complete and simplified QRS scores. CMR was performed within 1 week and 4 months thereafter to determine acute and chronic infarct size (IS) as well as microvascular obstruction (MVO). Results Complete and simplified QRS score showed comparable predictive value for acute (area under the curve (AUC) = 0.64 vs. 0.67) and chronic IS (AUC = 0.63 vs. 0.68) as well as for MVO (AUC = 0.64 vs. 0.66). Peak high sensitivity cardiac troponin T (hs-cTnT) showed an AUC of 0.88 for acute IS and 0.91 for chronic IS, respectively. For the prediction of MVO, peak hs-cTnT represented an AUC of 0.81. Conclusions In reperfused STEMI, complete and simplified QRS score displayed comparable value for the prediction of acute and chronic myocardial as well as microvascular damage. However, both QRS scoring systems provided inferior predictive validity, compared to peak hs-cTnT, the clinical reference method for IS estimation.
Collapse
Affiliation(s)
- Christina Tiller
- Cardiology and Angiology, University Clinic of Internal Medicine III, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
| | - Martin Reindl
- Cardiology and Angiology, University Clinic of Internal Medicine III, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
| | - Sebastian Johannes Reinstadler
- Cardiology and Angiology, University Clinic of Internal Medicine III, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
| | - Magdalena Holzknecht
- Cardiology and Angiology, University Clinic of Internal Medicine III, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
| | - Michael Schreinlechner
- Cardiology and Angiology, University Clinic of Internal Medicine III, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
| | - Alexander Peherstorfer
- Cardiology and Angiology, University Clinic of Internal Medicine III, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
| | - Nicolas Hein
- Cardiology and Angiology, University Clinic of Internal Medicine III, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
| | - Ivan Lechner
- Cardiology and Angiology, University Clinic of Internal Medicine III, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
| | - Agnes Mayr
- University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
| | - Gert Klug
- Cardiology and Angiology, University Clinic of Internal Medicine III, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
| | - Bernhard Metzler
- Cardiology and Angiology, University Clinic of Internal Medicine III, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria.
| |
Collapse
|
11
|
Reindl M, Tiller C, Holzknecht M, Lechner I, Beck A, Plappert D, Gorzala M, Pamminger M, Mayr A, Klug G, Bauer A, Metzler B, Reinstadler SJ. Prognostic Implications of Global Longitudinal Strain by Feature-Tracking Cardiac Magnetic Resonance in ST-Elevation Myocardial Infarction. Circ Cardiovasc Imaging 2019; 12:e009404. [DOI: 10.1161/circimaging.119.009404] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background:
The high accuracy of feature-tracking cardiac magnetic resonance (CMR) imaging qualifies this novel modality as potential gold standard for myocardial strain analyses in ST-elevation myocardial infarction patients; however, the incremental prognostic validity of feature-tracking-CMR over left ventricular ejection fraction (LVEF) and myocardial damage remains unclear. This study therefore aimed to determine the value of myocardial strain measured by feature-tracking-CMR for the prediction of clinical outcome following ST-elevation myocardial infarction.
Methods:
This prospective observational study enrolled 451 revascularized ST-elevation myocardial infarction patients. Comprehensive CMR investigations were performed 3 (interquartile range, 2–4) days after infarction to determine LVEF, global longitudinal strain (GLS), global radial strain, and global circumferential strain as well as myocardial damage. Primary end point was a composite of death, re-infarction, and congestive heart failure (major adverse cardiac events [MACE]).
Results:
During a follow-up of 24 (interquartile range, 11–48) months, 46 patients (10%) experienced a MACE event. All 3 strain indices were impaired in patients with MACE (all
P
<0.001). However, GLS emerged as the strongest MACE prognosticator among strain parameters (area under the curve, 0.73 [95% CI, 0.69–0.77]) and was significantly better (
P
=0.005) than LVEF (area under the curve, 0.64 [95% CI, 0.59–0.68]). The association between GLS and MACE remained significant (
P
<0.001) after adjustment for global radial strain, global circumferential strain, and LVEF as well as for infarct size and microvascular obstruction. The addition of GLS to a risk model comprising LVEF, infarct size, and microvascular obstruction led to a net reclassification improvement (0.35 [95% CI, 0.14–0.55];
P
<0.001).
Conclusions:
GLS by feature-tracking-CMR strongly and independently predicted the occurrence of medium-term MACE in contemporary revascularized ST-elevation myocardial infarction patients. Importantly, the prognostic value of GLS was superior and incremental to LVEF and CMR markers of infarct severity.
Collapse
Affiliation(s)
- Martin Reindl
- Department of Internal Medicine III, Cardiology and Angiology (M.R., C.T., M.H., I.L., A.B., D.P., M.G., G.K., A.B., B.M., S.J.R.), Medical University of Innsbruck, Austria
| | - Christina Tiller
- Department of Internal Medicine III, Cardiology and Angiology (M.R., C.T., M.H., I.L., A.B., D.P., M.G., G.K., A.B., B.M., S.J.R.), Medical University of Innsbruck, Austria
| | - Magdalena Holzknecht
- Department of Internal Medicine III, Cardiology and Angiology (M.R., C.T., M.H., I.L., A.B., D.P., M.G., G.K., A.B., B.M., S.J.R.), Medical University of Innsbruck, Austria
| | - Ivan Lechner
- Department of Internal Medicine III, Cardiology and Angiology (M.R., C.T., M.H., I.L., A.B., D.P., M.G., G.K., A.B., B.M., S.J.R.), Medical University of Innsbruck, Austria
| | - Alexander Beck
- Department of Internal Medicine III, Cardiology and Angiology (M.R., C.T., M.H., I.L., A.B., D.P., M.G., G.K., A.B., B.M., S.J.R.), Medical University of Innsbruck, Austria
| | - David Plappert
- Department of Internal Medicine III, Cardiology and Angiology (M.R., C.T., M.H., I.L., A.B., D.P., M.G., G.K., A.B., B.M., S.J.R.), Medical University of Innsbruck, Austria
| | - Michelle Gorzala
- Department of Internal Medicine III, Cardiology and Angiology (M.R., C.T., M.H., I.L., A.B., D.P., M.G., G.K., A.B., B.M., S.J.R.), Medical University of Innsbruck, Austria
| | - Mathias Pamminger
- Department of Radiology (M.P., A.M.), Medical University of Innsbruck, Austria
| | - Agnes Mayr
- Department of Radiology (M.P., A.M.), Medical University of Innsbruck, Austria
| | - Gert Klug
- Department of Internal Medicine III, Cardiology and Angiology (M.R., C.T., M.H., I.L., A.B., D.P., M.G., G.K., A.B., B.M., S.J.R.), Medical University of Innsbruck, Austria
| | - Axel Bauer
- Department of Internal Medicine III, Cardiology and Angiology (M.R., C.T., M.H., I.L., A.B., D.P., M.G., G.K., A.B., B.M., S.J.R.), Medical University of Innsbruck, Austria
| | - Bernhard Metzler
- Department of Internal Medicine III, Cardiology and Angiology (M.R., C.T., M.H., I.L., A.B., D.P., M.G., G.K., A.B., B.M., S.J.R.), Medical University of Innsbruck, Austria
| | - Sebastian J. Reinstadler
- Department of Internal Medicine III, Cardiology and Angiology (M.R., C.T., M.H., I.L., A.B., D.P., M.G., G.K., A.B., B.M., S.J.R.), Medical University of Innsbruck, Austria
| |
Collapse
|
12
|
Hwang JW, Yang JH, Song YB, Park TK, Lee JM, Kim JH, Jang WJ, Choi SH, Hahn JY, Choi JH, Ahn J, Carriere K, Lee SH, Gwon HC. Significado clínico de los cambios recíprocos del segmento ST en pacientes con IAMCEST: estudio de imagen con resonancia magnética cardiaca. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
13
|
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).
Collapse
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
| |
Collapse
|
14
|
Clinical Significance of Reciprocal ST-segment Changes in Patients With STEMI: A Cardiac Magnetic Resonance Imaging Study. ACTA ACUST UNITED AC 2018; 72:120-129. [PMID: 29478870 DOI: 10.1016/j.rec.2018.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 01/09/2018] [Indexed: 11/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES We sought to determine the association of reciprocal change in the ST-segment with myocardial injury assessed by cardiac magnetic resonance (CMR) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). METHODS We performed CMR imaging in 244 patients who underwent primary PCI for their first STEMI; CMR was performed a median 3 days after primary PCI. The first electrocardiogram was analyzed, and patients were stratified according to the presence of reciprocal change. The primary outcome was infarct size measured by CMR. Secondary outcomes were area at risk and myocardial salvage index. RESULTS Patients with reciprocal change (n=133, 54.5%) had a lower incidence of anterior infarction (27.8% vs 71.2%, P < .001) and shorter symptom onset to balloon time (221.5±169.8 vs 289.7±337.3min, P=.042). Using a multiple linear regression model, we found that patients with reciprocal change had a larger area at risk (P=.002) and a greater myocardial salvage index (P=.04) than patients without reciprocal change. Consequently, myocardial infarct size was not significantly different between the 2 groups (P=.14). The rate of major adverse cardiovascular events, including all-cause death, myocardial infarction, and repeat coronary revascularization, was similar between the 2 groups after 2 years of follow-up (P=.92). CONCLUSIONS Reciprocal ST-segment change was associated with larger extent of ischemic myocardium at risk and more myocardial salvage but not with final infarct size or adverse clinical outcomes in STEMI patients undergoing primary PCI.
Collapse
|
15
|
Aquaro GD, Di Bella G, Castelletti S, Maestrini V, Festa P, Ait-Ali L, Masci PG, Monti L, di Giovine G, De Lazzari M, Cipriani A, Guaricci AI, Dellegrottaglie S, Pepe A, Marra MP, Pontone G. Clinical recommendations of cardiac magnetic resonance, Part I: ischemic and valvular heart disease: a position paper of the working group 'Applicazioni della Risonanza Magnetica' of the Italian Society of Cardiology. J Cardiovasc Med (Hagerstown) 2017; 18:197-208. [PMID: 28072628 DOI: 10.2459/jcm.0000000000000498] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Cardiac magnetic resonance (CMR) has emerged as a reliable and accurate diagnostic tool for the evaluation of patients with cardiac disease in several clinical settings and with proven additional diagnostic and prognostic value compared with other imaging modalities. This document has been developed by the working group on the 'application of CMR' of the Italian Society of Cardiology to provide a perspective on the current state of technical advances and clinical applications of CMR and to inform cardiologists on how to implement their clinical and diagnostic pathways with the inclusion of this technique in clinical practice. The writing committee consisted of members of the working group of the Italian Society of Cardiology and two external peer reviewers with acknowledged experience in the field of CMR.
Collapse
Affiliation(s)
- Giovanni Donato Aquaro
- aU.O.C. Risonanza Magnetica per Immagini, Fondazione G. Monasterio CNR-Regione Toscana Pisa bUO Cardiologia, Università di Messina, Messina cIstituto Auxologico Italiano, Milano dDepartment of Cardiovascular, Respiratory, Geriatric, Anesthesiologic and Nephrologic Sciences, Sapienza University of Rome, Rome, Italy eCentre for Cardiac MR, Cardiology Unit, University Hospital Lausanne, Lausanne, Switzerland fU.O. Radiologia Diagnostica, Humanitas Hospital, Milan gDivision of Cardiology, Azienda Ospedaliera-Universitaria 'Maggiore della Carità', Eastern Piemont University, Novara hU.O. Clinica Cardiologica, Dipartimento di Scienze Cardiologiche, Toraciche e Vascolari, Università di Padova, Padua iUnità Operativa di Cardiologia Universitaria Dipartimento di Emergenze e Trapianti di Organi (D.E.T.O.) Azienda Ospedaliera Policlinico Consorziale di Bari, Bari jLaboratorio di RM Cardiovascolare Divisione di Cardiologia Clinica Villa dei Fiori, Acerra kU.O. Cardiologia, Centro Cardiologico Monzino, Milano, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
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.
Collapse
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.).
| |
Collapse
|
17
|
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.
Collapse
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.).
| |
Collapse
|
18
|
Secuencias de resonancia magnética cardiaca en T 2 para delimitar el miocardio isquémico en riesgo: ¿realidad o ficción? Rev Esp Cardiol (Engl Ed) 2017. [DOI: 10.1016/j.recesp.2016.09.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
19
|
Fernández-Friera L, García-Ruiz JM, García-Álvarez A, Fernández-Jiménez R, Sánchez-González J, Rossello X, Gómez-Talavera S, López-Martín GJ, Pizarro G, Fuster V, Ibáñez B. Impacto del territorio miocárdico infartado en la cuantificación del área en riesgo mediante cardiorresonancia magnética. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
20
|
Layland J, Rauhalammi S, Lee MMY, Ahmed N, Carberry J, Teng Yue May V, Watkins S, McComb C, Mangion K, McClure JD, Carrick D, O'Donnell A, Sood A, McEntegart M, Oldroyd KG, Radjenovic A, Berry C. Diagnostic Accuracy of 3.0-T Magnetic Resonance T1 and T2 Mapping and T2-Weighted Dark-Blood Imaging for the Infarct-Related Coronary Artery in Non-ST-Segment Elevation Myocardial Infarction. J Am Heart Assoc 2017; 6:JAHA.116.004759. [PMID: 28364045 PMCID: PMC5532996 DOI: 10.1161/jaha.116.004759] [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] [Indexed: 12/15/2022]
Abstract
BACKGROUND Patients with recent non-ST-segment elevation myocardial infarction commonly have heterogeneous characteristics that may be challenging to assess clinically. METHODS AND RESULTS We prospectively studied the diagnostic accuracy of 2 novel (T1, T2 mapping) and 1 established (T2-weighted short tau inversion recovery [T2W-STIR]) magnetic resonance imaging methods for imaging the ischemic area at risk and myocardial salvage in 73 patients with non-ST-segment elevation myocardial infarction (mean age 57±10 years, 78% male) at 3.0-T magnetic resonance imaging within 6.5±3.5 days of invasive management. The infarct-related territory was identified independently using a combination of angiographic, ECG, and clinical findings. The presence and extent of infarction was assessed with late gadolinium enhancement imaging (gadobutrol, 0.1 mmol/kg). The extent of acutely injured myocardium was independently assessed with native T1, T2, and T2W-STIR methods. The mean infarct size was 5.9±8.0% of left ventricular mass. The infarct zone T1 and T2 times were 1323±68 and 57±5 ms, respectively. The diagnostic accuracies of T1 and T2 mapping for identification of the infarct-related artery were similar (P=0.125), and both were superior to T2W-STIR (P<0.001). The extent of myocardial injury (percentage of left ventricular volume) estimated with T1 (15.8±10.6%) and T2 maps (16.0±11.8%) was similar (P=0.838) and moderately well correlated (r=0.82, P<0.001). Mean extent of acute injury estimated with T2W-STIR (7.8±11.6%) was lower than that estimated with T1 (P<0.001) or T2 maps (P<0.001). CONCLUSIONS In patients with non-ST-segment elevation myocardial infarction, T1 and T2 magnetic resonance imaging mapping have higher diagnostic performance than T2W-STIR for identifying the infarct-related artery. Compared with conventional STIR, T1 and T2 maps have superior value to inform diagnosis and revascularization planning in non-ST-segment elevation myocardial infarction. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT02073422.
Collapse
Affiliation(s)
- Jamie Layland
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom.,BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Samuli Rauhalammi
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Matthew M Y Lee
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom.,BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Nadeem Ahmed
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom.,BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Jaclyn Carberry
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Vannesa Teng Yue May
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Christie McComb
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Kenneth Mangion
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom.,BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - John D McClure
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - David Carrick
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom.,BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Anna O'Donnell
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Arvind Sood
- Hairmyres Hospital, East Kilbride, United Kingdom
| | - Margaret McEntegart
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Keith G Oldroyd
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Aleksandra Radjenovic
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Colin Berry
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom .,BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| |
Collapse
|
21
|
Kim PK, Hong YJ, Im DJ, Suh YJ, Park CH, Kim JY, Chang S, Lee HJ, Hur J, Kim YJ, Choi BW. Myocardial T1 and T2 Mapping: Techniques and Clinical Applications. Korean J Radiol 2017; 18:113-131. [PMID: 28096723 PMCID: PMC5240500 DOI: 10.3348/kjr.2017.18.1.113] [Citation(s) in RCA: 132] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 07/29/2016] [Indexed: 01/02/2023] Open
Abstract
Cardiac magnetic resonance (CMR) imaging is widely used in various medical fields related to cardiovascular diseases. Rapid technological innovations in magnetic resonance imaging in recent times have resulted in the development of new techniques for CMR imaging. T1 and T2 image mapping sequences enable the direct quantification of T1, T2, and extracellular volume fraction (ECV) values of the myocardium, leading to the progressive integration of these sequences into routine CMR settings. Currently, T1, T2, and ECV values are being recognized as not only robust biomarkers for diagnosis of cardiomyopathies, but also predictive factors for treatment monitoring and prognosis. In this study, we have reviewed various T1 and T2 mapping sequence techniques and their clinical applications.
Collapse
Affiliation(s)
- Pan Ki Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Yoo Jin Hong
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Dong Jin Im
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Young Joo Suh
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Chul Hwan Park
- Department of Radiology and Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Jin Young Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Suyon Chang
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Hye-Jeong Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Jin Hur
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Young Jin Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Byoung Wook Choi
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| |
Collapse
|
22
|
Stiermaier T, Thiele H, Eitel I. T 2-weighted Cardiovascular Magnetic Resonance Imaging to Delineate Ischemic Myocardium at Risk: Fact or Fiction? ACTA ACUST UNITED AC 2016; 70:316-317. [PMID: 27890444 DOI: 10.1016/j.rec.2016.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 10/04/2016] [Indexed: 11/15/2022]
Affiliation(s)
- Thomas Stiermaier
- University Heart Center of Lübeck, Medical Clinic II, Department of Cardiology, Angiology, Intensive Care Medicine, Lübeck, Germany and German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Holger Thiele
- University Heart Center of Lübeck, Medical Clinic II, Department of Cardiology, Angiology, Intensive Care Medicine, Lübeck, Germany and German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Ingo Eitel
- University Heart Center of Lübeck, Medical Clinic II, Department of Cardiology, Angiology, Intensive Care Medicine, Lübeck, Germany and German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany.
| |
Collapse
|
23
|
Fernández-Friera L, García-Ruiz JM, García-Álvarez A, Fernández-Jiménez R, Sánchez-González J, Rossello X, Gómez-Talavera S, López-Martín GJ, Pizarro G, Fuster V, Ibáñez B. Accuracy of Area at Risk Quantification by Cardiac Magnetic Resonance According to the Myocardial Infarction Territory. ACTA ACUST UNITED AC 2016; 70:323-330. [PMID: 27592277 DOI: 10.1016/j.rec.2016.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 07/11/2016] [Indexed: 12/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES Area at risk (AAR) quantification is important to evaluate the efficacy of cardioprotective therapies. However, postinfarction AAR assessment could be influenced by the infarcted coronary territory. Our aim was to determine the accuracy of T2-weighted short tau triple-inversion recovery (T2W-STIR) cardiac magnetic resonance (CMR) imaging for accurate AAR quantification in anterior, lateral, and inferior myocardial infarctions. METHODS Acute reperfused myocardial infarction was experimentally induced in 12 pigs, with 40-minute occlusion of the left anterior descending (n = 4), left circumflex (n = 4), and right coronary arteries (n = 4). Perfusion CMR was performed during selective intracoronary gadolinium injection at the coronary occlusion site (in vivo criterion standard) and, additionally, a 7-day CMR, including T2W-STIR sequences, was performed. Finally, all animals were sacrificed and underwent postmortem Evans blue staining (classic criterion standard). RESULTS The concordance between the CMR-based criterion standard and T2W-STIR to quantify AAR was high for anterior and inferior infarctions (r = 0.73; P = .001; mean error = 0.50%; limits = -12.68%-13.68% and r = 0.87; P = .001; mean error = -1.5%; limits = -8.0%-5.8%, respectively). Conversely, the correlation for the circumflex territories was poor (r = 0.21, P = .37), showing a higher mean error and wider limits of agreement. A strong correlation between pathology and the CMR-based criterion standard was observed (r = 0.84, P < .001; mean error = 0.91%; limits = -7.55%-9.37%). CONCLUSIONS T2W-STIR CMR sequences are accurate to determine the AAR for anterior and inferior infarctions; however, their accuracy for lateral infarctions is poor. These findings may have important implications for the design and interpretation of clinical trials evaluating the effectiveness of cardioprotective therapies.
Collapse
Affiliation(s)
- Leticia Fernández-Friera
- Área de Fisiopatología Vascular, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Unidad de Imagen Cardiaca Avanzada, Departamento de Cardiología, Hospital Universitario HM Montepríncipe, Madrid, Spain
| | - José Manuel García-Ruiz
- Área de Fisiopatología del Miocardio, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Departamento de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Ana García-Álvarez
- Área de Fisiopatología del Miocardio, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Unidad de Insuficiencia Cardiaca, Departamento de Cardiología, Hospital Clínic, Barcelona, Spain
| | - Rodrigo Fernández-Jiménez
- Área de Fisiopatología del Miocardio, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Departamento de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
| | - Javier Sánchez-González
- Área de Fisiopatología del Miocardio, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Departamento de Ciencia Clínica, Philips Healthcare Iberia, Madrid, Spain
| | - Xavier Rossello
- Área de Fisiopatología del Miocardio, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom
| | - Sandra Gómez-Talavera
- Área de Fisiopatología del Miocardio, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Servicio de Cardiología, IIS-Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Gonzalo J López-Martín
- Área de Fisiopatología del Miocardio, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | - Gonzalo Pizarro
- Área de Fisiopatología Vascular, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Departamento de Cardiología, Complejo Hospitalario Ruber Juan Bravo, Universidad Europea de Madrid (UEM), Madrid, Spain
| | - Valentín Fuster
- Área de Fisiopatología Vascular, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, United States
| | - Borja Ibáñez
- Área de Fisiopatología Vascular, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Servicio de Cardiología, IIS-Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
| |
Collapse
|
24
|
Nordlund D, Heiberg E, Carlsson M, Fründ ET, Hoffmann P, Koul S, Atar D, Aletras AH, Erlinge D, Engblom H, Arheden H. Extent of Myocardium at Risk for Left Anterior Descending Artery, Right Coronary Artery, and Left Circumflex Artery Occlusion Depicted by Contrast-Enhanced Steady State Free Precession and T2-Weighted Short Tau Inversion Recovery Magnetic Resonance Imaging. Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.115.004376. [DOI: 10.1161/circimaging.115.004376] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 05/13/2016] [Indexed: 11/16/2022]
Abstract
Background—
Contrast-enhanced steady state free precession (CE-SSFP) and T2-weighted short tau inversion recovery (T2-STIR) have been clinically validated to estimate myocardium at risk (MaR) by cardiovascular magnetic resonance while using myocardial perfusion single-photon emission computed tomography as reference standard. Myocardial perfusion single-photon emission computed tomography has been used to describe the coronary perfusion territories during myocardial ischemia. Compared with myocardial perfusion single-photon emission computed tomography, cardiovascular magnetic resonance offers superior image quality and practical advantages. Therefore, the aim was to describe the main coronary perfusion territories using CE-SSFP and T2-STIR cardiovascular magnetic resonance data in patients after acute ST-segment–elevation myocardial infarction.
Methods and Results—
CE-SSFP and T2-STIR data from 2 recent multicenter trials, CHILL-MI and MITOCARE (n=215), were used to assess MaR. Angiography was used to determine culprit vessel. Of 215 patients, 39% had left anterior descending artery occlusion, 49% had right coronary artery occlusion, and 12% had left circumflex artery occlusion. Mean extent of MaR using CE-SSFP was 44±10% for left anterior descending artery, 31±7% for right coronary artery, and 30±9% for left circumflex artery. Using T2-STIR, MaR was 44±9% for left anterior descending artery, 30±8% for right coronary artery, and 30±12% for left circumflex artery. MaR was visualized in polar plots, and expected overlap was found between right coronary artery and left circumflex artery. Detailed regional data are presented for use in software algorithms as a priori information on the extent of MaR.
Conclusions—
For the first time, cardiovascular magnetic resonance has been used to show the main coronary perfusion territories using CE-SSFP and T2-STIR. The good agreement between CE-SSFP and T2-STIR from this study and myocardial perfusion single-photon emission computed tomography from previous studies indicates that these 3 methods depict MaR accurately in individual patients and at a group level.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifiers: NCT01379261 and NCT01374321.
Collapse
Affiliation(s)
- David Nordlund
- From the Cardiac MR Group, Department of Clinical Physiology (D.N., E.H., M.C., A.H.A., H.E., H.A.) and Department of Cardiology (S.K., D.E.), Skåne University Hospital, Lund University, Sweden; Department of Radiology, Odense University Hospital, Denmark (E.-T.F.); Section for Interventional Cardiology, Division of Cardiovascular and Pulmonary Diseases, Department of Cardiology, Oslo University Hospital, Ullevaal, Norway (P.H.); Department of Cardiology B, Oslo University Hospital Ullevål, and
| | - Einar Heiberg
- From the Cardiac MR Group, Department of Clinical Physiology (D.N., E.H., M.C., A.H.A., H.E., H.A.) and Department of Cardiology (S.K., D.E.), Skåne University Hospital, Lund University, Sweden; Department of Radiology, Odense University Hospital, Denmark (E.-T.F.); Section for Interventional Cardiology, Division of Cardiovascular and Pulmonary Diseases, Department of Cardiology, Oslo University Hospital, Ullevaal, Norway (P.H.); Department of Cardiology B, Oslo University Hospital Ullevål, and
| | - Marcus Carlsson
- From the Cardiac MR Group, Department of Clinical Physiology (D.N., E.H., M.C., A.H.A., H.E., H.A.) and Department of Cardiology (S.K., D.E.), Skåne University Hospital, Lund University, Sweden; Department of Radiology, Odense University Hospital, Denmark (E.-T.F.); Section for Interventional Cardiology, Division of Cardiovascular and Pulmonary Diseases, Department of Cardiology, Oslo University Hospital, Ullevaal, Norway (P.H.); Department of Cardiology B, Oslo University Hospital Ullevål, and
| | - Ernst-Torben Fründ
- From the Cardiac MR Group, Department of Clinical Physiology (D.N., E.H., M.C., A.H.A., H.E., H.A.) and Department of Cardiology (S.K., D.E.), Skåne University Hospital, Lund University, Sweden; Department of Radiology, Odense University Hospital, Denmark (E.-T.F.); Section for Interventional Cardiology, Division of Cardiovascular and Pulmonary Diseases, Department of Cardiology, Oslo University Hospital, Ullevaal, Norway (P.H.); Department of Cardiology B, Oslo University Hospital Ullevål, and
| | - Pavel Hoffmann
- From the Cardiac MR Group, Department of Clinical Physiology (D.N., E.H., M.C., A.H.A., H.E., H.A.) and Department of Cardiology (S.K., D.E.), Skåne University Hospital, Lund University, Sweden; Department of Radiology, Odense University Hospital, Denmark (E.-T.F.); Section for Interventional Cardiology, Division of Cardiovascular and Pulmonary Diseases, Department of Cardiology, Oslo University Hospital, Ullevaal, Norway (P.H.); Department of Cardiology B, Oslo University Hospital Ullevål, and
| | - Sasha Koul
- From the Cardiac MR Group, Department of Clinical Physiology (D.N., E.H., M.C., A.H.A., H.E., H.A.) and Department of Cardiology (S.K., D.E.), Skåne University Hospital, Lund University, Sweden; Department of Radiology, Odense University Hospital, Denmark (E.-T.F.); Section for Interventional Cardiology, Division of Cardiovascular and Pulmonary Diseases, Department of Cardiology, Oslo University Hospital, Ullevaal, Norway (P.H.); Department of Cardiology B, Oslo University Hospital Ullevål, and
| | - Dan Atar
- From the Cardiac MR Group, Department of Clinical Physiology (D.N., E.H., M.C., A.H.A., H.E., H.A.) and Department of Cardiology (S.K., D.E.), Skåne University Hospital, Lund University, Sweden; Department of Radiology, Odense University Hospital, Denmark (E.-T.F.); Section for Interventional Cardiology, Division of Cardiovascular and Pulmonary Diseases, Department of Cardiology, Oslo University Hospital, Ullevaal, Norway (P.H.); Department of Cardiology B, Oslo University Hospital Ullevål, and
| | - Anthony H. Aletras
- From the Cardiac MR Group, Department of Clinical Physiology (D.N., E.H., M.C., A.H.A., H.E., H.A.) and Department of Cardiology (S.K., D.E.), Skåne University Hospital, Lund University, Sweden; Department of Radiology, Odense University Hospital, Denmark (E.-T.F.); Section for Interventional Cardiology, Division of Cardiovascular and Pulmonary Diseases, Department of Cardiology, Oslo University Hospital, Ullevaal, Norway (P.H.); Department of Cardiology B, Oslo University Hospital Ullevål, and
| | - David Erlinge
- From the Cardiac MR Group, Department of Clinical Physiology (D.N., E.H., M.C., A.H.A., H.E., H.A.) and Department of Cardiology (S.K., D.E.), Skåne University Hospital, Lund University, Sweden; Department of Radiology, Odense University Hospital, Denmark (E.-T.F.); Section for Interventional Cardiology, Division of Cardiovascular and Pulmonary Diseases, Department of Cardiology, Oslo University Hospital, Ullevaal, Norway (P.H.); Department of Cardiology B, Oslo University Hospital Ullevål, and
| | - Henrik Engblom
- From the Cardiac MR Group, Department of Clinical Physiology (D.N., E.H., M.C., A.H.A., H.E., H.A.) and Department of Cardiology (S.K., D.E.), Skåne University Hospital, Lund University, Sweden; Department of Radiology, Odense University Hospital, Denmark (E.-T.F.); Section for Interventional Cardiology, Division of Cardiovascular and Pulmonary Diseases, Department of Cardiology, Oslo University Hospital, Ullevaal, Norway (P.H.); Department of Cardiology B, Oslo University Hospital Ullevål, and
| | - Håkan Arheden
- From the Cardiac MR Group, Department of Clinical Physiology (D.N., E.H., M.C., A.H.A., H.E., H.A.) and Department of Cardiology (S.K., D.E.), Skåne University Hospital, Lund University, Sweden; Department of Radiology, Odense University Hospital, Denmark (E.-T.F.); Section for Interventional Cardiology, Division of Cardiovascular and Pulmonary Diseases, Department of Cardiology, Oslo University Hospital, Ullevaal, Norway (P.H.); Department of Cardiology B, Oslo University Hospital Ullevål, and
| |
Collapse
|
25
|
Abstract
Sarcoidosis is a multisystem disorder of unknown cause, and cardiac sarcoidosis affects at least 25% of patients and accounts for substantial mortality and morbidity from this disease. Cardiac sarcoidosis may present with heart failure, left ventricular systolic dysfunction, AV block, atrial or ventricular arrhythmias, and sudden cardiac death. Cardiac involvement can be challenging to detect and diagnose because of the focal nature of the disease, as well as the fact that clinical criteria have limited diagnostic accuracy. Nevertheless, the diagnosis of cardiac sarcoidosis can be enhanced by integrating both clinical and imaging findings. This article reviews the various roles that different imaging modalities provide in the evaluation and management of patients with known or suspected cardiac sarcoidosis.
Collapse
Affiliation(s)
- Ron Blankstein
- From the Non-Invasive Cardiovascular Imaging Program, Department of Medicine (Cardiovascular Division) and Department of Radiology, Brigham and Women’s Hospital, Boston, MA (R.B.); and Department of Medicine (Cardiology Division) and Department of Radiology, Rutgers New Jersey Medical School, Newark (A.H.W.)
| | - Alfonso H. Waller
- From the Non-Invasive Cardiovascular Imaging Program, Department of Medicine (Cardiovascular Division) and Department of Radiology, Brigham and Women’s Hospital, Boston, MA (R.B.); and Department of Medicine (Cardiology Division) and Department of Radiology, Rutgers New Jersey Medical School, Newark (A.H.W.)
| |
Collapse
|
26
|
Yeh FC, Liu L, Hitchens TK, Wu YL. Mapping immune cell infiltration using restricted diffusion MRI. Magn Reson Med 2016; 77:603-612. [PMID: 26843524 DOI: 10.1002/mrm.26143] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 01/04/2016] [Accepted: 01/05/2016] [Indexed: 12/15/2022]
Abstract
PURPOSE Diffusion MRI provides a noninvasive way to assess tissue microstructure. Based on diffusion MRI, we propose a model-free method called restricted diffusion imaging (RDI) to quantify restricted diffusion and correlate it with cellularity. THEORY AND METHODS An analytical relation between q-space signals and the density of restricted spins was derived to quantify restricted diffusion. A phantom study was conducted to investigate the performance of RDI, and RDI was applied to an animal study to assess immune cell infiltration in myocardial tissues with ischemia-reperfusion injury. RESULTS Our phantom study showed a correlation coefficient of 0.998 between cell density and the restricted diffusion quantified by RDI. The animal study also showed that the high-value regions in RDI matched well with the macrophage infiltration areas in the H&E stained slides. In comparison with diffusion tensor imaging (DTI), RDI exhibited its outperformance to detect macrophage infiltration and delineate inflammatory myocardium. CONCLUSION RDI can be used to reveal cell density and detect immune cell infiltration. RDI exhibits better specificity than the diffusivity measurement derived from DTI. Magn Reson Med 77:603-612, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
Collapse
Affiliation(s)
- Fang-Cheng Yeh
- Department of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Li Liu
- Department of Biological Sciences, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - T Kevin Hitchens
- Animal Imaging Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Neurobiology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yijen L Wu
- Rangos Research Center Animal Imaging Core, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Developmental Biology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
27
|
Fernández-Jiménez R, Sánchez-González J, Aguero J, Del Trigo M, Galán-Arriola C, Fuster V, Ibáñez B. Fast T2 gradient-spin-echo (T2-GraSE) mapping for myocardial edema quantification: first in vivo validation in a porcine model of ischemia/reperfusion. J Cardiovasc Magn Reson 2015; 17:92. [PMID: 26538198 PMCID: PMC4634909 DOI: 10.1186/s12968-015-0199-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 10/28/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Several T2-mapping sequences have been recently proposed to quantify myocardial edema by providing T2 relaxation time values. However, no T2-mapping sequence has ever been validated against actual myocardial water content for edema detection. In addition, these T2-mapping sequences are either time-consuming or require specialized software for data acquisition and/or post-processing, factors impeding their routine clinical use. Our objective was to obtain in vivo validation of a sequence for fast and accurate myocardial T2-mapping (T2 gradient-spin-echo [GraSE]) that can be easily integrated in routine protocols. METHODS The study population comprised 25 pigs. Closed-chest 40 min ischemia/reperfusion was performed in 20 pigs. Pigs were sacrificed at 120 min (n = 5), 24 h (n = 5), 4 days (n = 5) and 7 days (n = 5) after reperfusion, and heart tissue extracted for quantification of myocardial water content. For the evaluation of T2 relaxation time, cardiovascular magnetic resonance (CMR) scans, including T2 turbo-spin-echo (T2-TSE, reference standard) mapping and T2-GraSE mapping, were performed at baseline and at every follow-up until sacrifice. Five additional pigs were sacrificed after baseline CMR study and served as controls. RESULTS Acquisition of T2-GraSE mapping was significantly (3-fold) faster than conventional T2-TSE mapping. Myocardial T2 relaxation measurements performed by T2-TSE and T2-GraSE mapping demonstrated an almost perfect correlation (R(2) = 0.99) and agreement with no systematic error between techniques. The two T2-mapping sequences showed similarly good correlations with myocardial water content: R(2) = 0.75 and R(2) = 0.73 for T2-TSE and T2-GraSE mapping, respectively. CONCLUSIONS We present the first in vivo validation of T2-mapping to assess myocardial edema. Given its shorter acquisition time and no requirement for specific software for data acquisition or post-processing, fast T2-GraSE mapping of the myocardium offers an attractive alternative to current CMR sequences for T2 quantification.
Collapse
Affiliation(s)
- Rodrigo Fernández-Jiménez
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
- Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Javier Sánchez-González
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
- Philips Healthcare, Madrid, Spain
| | - Jaume Aguero
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | - María Del Trigo
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | - Carlos Galán-Arriola
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | - Valentin Fuster
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
- The Zena and Michael A. Wiener CVI, Mount Sinai School of Medicine, New York, NY, USA
| | - Borja Ibáñez
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.
- Department of Cardiology, Instituto de Investigación Sanitaria, Fundación Jiménez Díaz Hospital, Madrid, Spain.
| |
Collapse
|
28
|
Xia R, Lu X, Zhang B, Wang Y, Liao J, Zheng J, Gao F. Assessment of myocardial edema and area at risk in a rat model of myocardial infarction with a faster T2 mapping method. Acta Radiol 2015; 56:1085-90. [PMID: 25182806 DOI: 10.1177/0284185114547899] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 07/10/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND The common T2 mapping is not suitable for the use in rat heart with high heart rate, unless data are acquired in multiple cardiac cycles. PURPOSE To evaluate a simplified T2 mapping method for faster assessment of myocardial edema and area at risk in a rat model of myocardial infarction. MATERIAL AND METHODS The simplified T2 mapping method (TR/TE, 1500 ms/10, 20, 30 ms) was implemented at a 7.0T MRI system. The accuracy of T2 mapping was compared with a standard T2 mapping method (TR, 2500 ms, 16 TEs equally spaced from 11 ms to 176 ms) in thigh muscles in rats (n = 6) and a phantom. This method was further evaluated in normal rats (n = 8) and rats with myocardial infarction (n = 8). Late gadolinium enhancement images were also acquired in the rats with myocardial infarction. RESULTS T2 values of simplified T2 mapping in the muscles and phantom were 27.3 ± 2 ms and 26.5 ± 1.1 ms, which were similar to the T2 values obtained by the standard T2 mapping method (28.1 ± 1.4 ms, P > 0.05; 26.9 ± 1.7 ms). No significant difference in T2 distribution (different segments and slices from base to apex) in the whole heart was found in normal rats (25.6 ± 3.3 ms, P > 0.05). The mean T2 value in the myocardial edema regions of myocardial infarction rats (37 ± 4.9 ms) was significantly higher than that of the normal rats (25.6 ± 3.3 ms, P < 0.001). The T2 value in the myocardial infarction core of myocardial infarction rats (39.9 ± 3.6 ms) was significantly higher than that of area at risk (34.7 ± 2.9 ms, P < 0.001). CONCLUSION The simplified myocardial T2 mapping is technically feasible and accurate, and can readily detect myocardial edema and area at risk in rats with high heart rate.
Collapse
Affiliation(s)
- Rui Xia
- Molecular Imaging Laboratory, Department of Radiology, West China Hospital, Sichuan University, PR China
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, PR China
| | - Xi Lu
- Molecular Imaging Laboratory, Department of Radiology, West China Hospital, Sichuan University, PR China
| | - Bing Zhang
- Molecular Imaging Laboratory, Department of Radiology, West China Hospital, Sichuan University, PR China
| | - Yuqing Wang
- Molecular Imaging Laboratory, Department of Radiology, West China Hospital, Sichuan University, PR China
| | - Jichun Liao
- Molecular Imaging Laboratory, Department of Radiology, West China Hospital, Sichuan University, PR China
| | - Jie Zheng
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, MO, USA
| | - Fabao Gao
- Molecular Imaging Laboratory, Department of Radiology, West China Hospital, Sichuan University, PR China
| |
Collapse
|
29
|
Park CH, Choi EY, Yoon YW, Kwon HM, Hong BK, Lee BK, Min PK, Greiser A, Paek MY, Hwang SH, Kim TH. Quantitative T2 mapping after reperfusion therapy in patients with acute myocardial infarction: A comparison with late gadolinium enhancement and cine MR imaging. Magn Reson Imaging 2015; 33:1246-1252. [PMID: 26278969 DOI: 10.1016/j.mri.2015.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 04/07/2015] [Accepted: 08/08/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE This study evaluates myocardial edema by quantitative T2 mapping in patients with acute myocardial infarction (AMI) and compares the lateral extent of myocardial edema with those of infarcted and dysfunctional myocardium. MATERIALS AND METHODS Cardiac magnetic resonance images (MRIs) of 31 patients (M:F=29:2, mean age: 52.5±10.8years) with AMI were reviewed. On cine-MRI, all short axis images of the left ventricle (LV) were divided into 60 sectors. The regional wall motion of each sector was calculated as follows: systolic wall thickening (SWT, %)=[(LV wall thicknessES-LV wall thicknessED)/LV wall thicknessED]*100. Dysfunctional myocardium was defined as sectors with decreased SWT lower than 40%. On LGE-images, myocardial infarction was defined as an area of hyper-enhancement more than 5 SDs from the remote myocardium. On T2 map, myocardial edema was defined as an area in which T2 values were at least 2 SDs higher than those from remote myocardium. The lateral extents of infarcted myocardium, myocardial edema, and dysfunctional myocardium were calculated as the percentage of central angles ((central angle of the involved myocardium/360)*100 (%)) and then compared. RESULTS The lateral extent of myocardial edema was slightly larger than that of infarcted myocardium (37.4±13.3% vs. 35±12.9%, p<0.01). The lateral extent of dysfunctional myocardium (50.6±15.3%) was significantly larger than that of infarcted myocardium or myocardial edema (p<0.001). CONCLUSIONS The lateral extent of myocardial edema beyond the infarcted myocardium might be narrow, but the dysfunctional myocardium could be significantly larger than myocardial edema, suggesting stunned myocardium without edema.
Collapse
Affiliation(s)
- Chul Hwan Park
- Department of Radiology and Research Institute of Radiological Science, Yonsei University Health System, Seoul 135-720, Republic of Korea
| | - Eui-Young Choi
- Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Won Yoon
- Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyuck Moon Kwon
- Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Bum Kee Hong
- Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byoung Kwon Lee
- Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Pil-Ki Min
- Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Sung Ho Hwang
- Department of Radiology and Research Institute of Radiological Science, Yonsei University Health System, Seoul 135-720, Republic of Korea
| | - Tae Hoon Kim
- Department of Radiology and Research Institute of Radiological Science, Yonsei University Health System, Seoul 135-720, Republic of Korea.
| |
Collapse
|
30
|
Bietenbeck M, Florian A, Sechtem U, Yilmaz A. The diagnostic value of iron oxide nanoparticles for imaging of myocardial inflammation--quo vadis? J Cardiovasc Magn Reson 2015; 17:54. [PMID: 26152269 PMCID: PMC4495803 DOI: 10.1186/s12968-015-0165-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 06/24/2015] [Indexed: 01/23/2023] Open
Abstract
Cardiovascular magnetic resonance (CMR) is an integral part in the diagnostic work-up of cardiac inflammatory diseases. In this context, superparamagnetic iron oxide-based contrast agents can provide additional diagnostic information regarding the assessment of myocardial infarction and myocarditis. After intravenous administration, these nanoparticles are taken up by activated monocytes and macrophages, which predominantly accumulate in regions associated with inflammation as was successfully shown in recent preclinical studies. Furthermore, first clinical studies with a new iron oxide-complex that was clinically approved for the treatment of iron deficiency anaemia recently demonstrated a superior diagnostic value of iron oxide nanoparticles compared to gadolinium-based compounds for imaging of myocardial inflammation in patients with acute myocardial infarction. In this article, we outline the basic features of superparamagnetic iron oxide-based contrast agents and review recent studies using such nanoparticles for cardiac imaging in case of acute myocardial infarction as well as acute myocarditis. Moreover, we highlight the translational potential of these agents and possible research applications with regard to imaging and therapy.
Collapse
Affiliation(s)
- Michael Bietenbeck
- Department of Cardiology and Angiology, Albert-Schweitzer-Campus 1, building A1, 48149, Münster, Germany
| | - Anca Florian
- Department of Cardiology and Angiology, Albert-Schweitzer-Campus 1, building A1, 48149, Münster, Germany
| | - Udo Sechtem
- Division of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Ali Yilmaz
- Department of Cardiology and Angiology, Albert-Schweitzer-Campus 1, building A1, 48149, Münster, Germany.
| |
Collapse
|
31
|
van der Pals J, Hammer-Hansen S, Nielles-Vallespin S, Kellman P, Taylor J, Kozlov S, Hsu LY, Chen MY, Arai AE. Temporal and spatial characteristics of the area at risk investigated using computed tomography and T1-weighted magnetic resonance imaging. Eur Heart J Cardiovasc Imaging 2015; 16:1232-40. [PMID: 25881901 PMCID: PMC4609161 DOI: 10.1093/ehjci/jev072] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 03/05/2015] [Indexed: 12/17/2022] Open
Abstract
Aims Cardiovascular magnetic resonance (CMR) imaging can measure the myocardial area at risk (AAR), but the technique has received criticism for inadequate validation. CMR commonly depicts an AAR that is wider than the infarct, which in turn would require a lateral perfusion gradient within the AAR. We investigated the presence of a lateral perfusion gradient within the AAR and validated CMR measures of AAR against three independent reference standards of high quality. Methods and results Computed tomography (CT) perfusion imaging, microsphere blood flow analysis, T1-weighted 3T CMR and fluorescent microparticle pathology were used to investigate the AAR in a canine model (n = 10) of ischaemia and reperfusion. AAR size by CMR correlated well with CT (R2 = 0.80), microsphere blood flow (R2 = 0.80), and pathology (R2 = 0.74) with good limits of agreement [−0.79 ± 4.02% of the left ventricular mass (LVM) vs. CT; −1.49 ± 4.04% LVM vs. blood flow and −1.01 ± 4.18% LVM vs. pathology]. The lateral portion of the AAR had higher perfusion than the core of the AAR by CT perfusion imaging (40.7 ± 11.8 vs. 25.2 ± 17.7 Hounsfield units, P = 0.0008) and microsphere blood flow (0.11 ± 0.04 vs. 0.05 ± 0.02 mL/g/min, lateral vs. core, P = 0.001). The transmural extent of MI was lower in the lateral portion of the AAR than the core (28.2 ± 10.2 vs. 17.4 ± 8.4% of the wall, P = 0.001). Conclusion T1-weighted CMR accurately quantifies size of the AAR with excellent agreement compared with three independent reference standards. A lateral perfusion gradient results in lower transmural extent of infarction at the edges of the AAR compared with the core.
Collapse
Affiliation(s)
- Jesper van der Pals
- National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Building 10, Room B1D416, MSC 1061, 10 Center Drive, Bethesda, MD 20892-1061, USA
| | - Sophia Hammer-Hansen
- National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Building 10, Room B1D416, MSC 1061, 10 Center Drive, Bethesda, MD 20892-1061, USA
| | - Sonia Nielles-Vallespin
- National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Building 10, Room B1D416, MSC 1061, 10 Center Drive, Bethesda, MD 20892-1061, USA
| | - Peter Kellman
- National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Building 10, Room B1D416, MSC 1061, 10 Center Drive, Bethesda, MD 20892-1061, USA
| | - Joni Taylor
- National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Building 10, Room B1D416, MSC 1061, 10 Center Drive, Bethesda, MD 20892-1061, USA
| | - Shawn Kozlov
- National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Building 10, Room B1D416, MSC 1061, 10 Center Drive, Bethesda, MD 20892-1061, USA
| | - Li-Yueh Hsu
- National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Building 10, Room B1D416, MSC 1061, 10 Center Drive, Bethesda, MD 20892-1061, USA
| | - Marcus Y Chen
- National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Building 10, Room B1D416, MSC 1061, 10 Center Drive, Bethesda, MD 20892-1061, USA
| | - Andrew E Arai
- National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Building 10, Room B1D416, MSC 1061, 10 Center Drive, Bethesda, MD 20892-1061, USA
| |
Collapse
|
32
|
McAlindon E, Pufulete M, Lawton C, Angelini GD, Bucciarelli-Ducci C. Quantification of infarct size and myocardium at risk: evaluation of different techniques and its implications. Eur Heart J Cardiovasc Imaging 2015; 16:738-46. [PMID: 25736308 PMCID: PMC4463003 DOI: 10.1093/ehjci/jev001] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 12/31/2014] [Indexed: 12/18/2022] Open
Abstract
AIMS The aim of this study was to evaluate seven methods for quantifying myocardial oedema [2 standard deviation (SD), 3 SD, 5 SD, full width at half maximum (FWHM), Otsu method, manual thresholding, and manual contouring] from T2-weighted short tau inversion recovery (T2w STIR) and also to reassess these same seven methods for quantifying acute infarct size following ST-segment myocardial infarction (STEMI). This study focuses on test-retest repeatability while assessing inter- and intraobserver variability. T2w STIR and late gadolinium enhancement (LGE) are the most widely used cardiovascular magnetic resonance (CMR) techniques to image oedema and infarction, respectively. However, no consensus exists on the best quantification method to be used to analyse these images. This has potential important implications in the research setting where both myocardial oedema and infarct size are increasingly used and measured as surrogate endpoints in clinical trials. METHODS AND RESULTS Forty patients day 2 following acute reperfused STEMI were scanned for myocardial oedema and infarction (LGE). All patients had a second CMR scan on the same day >6 h apart from the first one. Images were analysed offline by two independent observers using the semi-automated software. Both oedema and LGE were quantified using seven techniques (2 SD, 3 SD, 5 SD, Otsu, FWHM, manual threshold, and manual contouring). Interobserver, intraobserver and test-retest agreement and variability for both infarct size and oedema quantification were assessed. Infarct size and myocardial quantification vary depending on the quantification method used. Overall, manual contouring provided the lowest inter-, intraobserver, and interscan variability for both infarct size and oedema quantification. The FWHM method for infarct size quantification and the Otsu method for myocardial oedema quantification are acceptable alternatives. CONCLUSIONS This study determines that, in acute myocardial infarction (MI), manual contouring has the lowest overall variability for quantification of both myocardial oedema and MI when analysed by experienced observers.
Collapse
Affiliation(s)
- Elisa McAlindon
- NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, Level 7 Queens Building, Bristol Royal Infirmary, Bristol BS2 8HW, UK
| | - Maria Pufulete
- Clinical Trial and Evaluation Unit (CTEU), University of Bristol, Bristol, UK
| | - Chris Lawton
- NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, Level 7 Queens Building, Bristol Royal Infirmary, Bristol BS2 8HW, UK
| | - Gianni D Angelini
- NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, Level 7 Queens Building, Bristol Royal Infirmary, Bristol BS2 8HW, UK
| | - Chiara Bucciarelli-Ducci
- NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, Level 7 Queens Building, Bristol Royal Infirmary, Bristol BS2 8HW, UK
| |
Collapse
|
33
|
Consideration of QRS complex in addition to ST-segment abnormalities in the estimation of the “risk region” during acute anterior or inferior myocardial infarction. J Electrocardiol 2014; 47:535-9. [DOI: 10.1016/j.jelectrocard.2014.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Indexed: 11/21/2022]
|
34
|
Eitel I, Thiele H. Importance of visualization the myocardium at risk in myocardial infarction. Eur Heart J Cardiovasc Imaging 2014; 15:1054-5. [PMID: 24925146 DOI: 10.1093/ehjci/jeu095] [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: 11/14/2022] Open
Affiliation(s)
- Ingo Eitel
- Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Medical Clinic II, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, Lübeck 23538, Germany
| | - Holger Thiele
- Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Medical Clinic II, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, Lübeck 23538, Germany
| |
Collapse
|
35
|
Krieghoff C, Barten MJ, Hildebrand L, Grothoff M, Lehmkuhl L, Lücke C, Andres C, Nitzsche S, Riese F, Strüber M, Mohr FW, Gutberlet M. Assessment of sub-clinical acute cellular rejection after heart transplantation: comparison of cardiac magnetic resonance imaging and endomyocardial biopsy. Eur Radiol 2014; 24:2360-71. [PMID: 24895035 PMCID: PMC4155184 DOI: 10.1007/s00330-014-3246-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Revised: 03/31/2014] [Accepted: 05/15/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Comparing the diagnostic value of multi-sequential cardiac magnetic resonance imaging (CMR) with endomyocardial biopsy (EMB) for sub-clinical cardiac allograft rejection. METHODS One hundred and forty-six examinations in 73 patients (mean age 53 ± 12 years, 58 men) were performed using a 1.5 Tesla system and compared to EMB. Examinations included a STIR (short tau inversion recovery) sequence for calculation of edema ratio (ER), a T1-weighted spin-echo sequence for assessment of global relative enhancement (gRE), and inversion-recovery sequences to visualize late gadolinium enhancement (LGE). Histological grade ≥1B was considered relevant rejection. RESULTS One hundred and twenty-seven (127/146 = 87 %) EMBs demonstrated no or mild signs of rejection (grades ≤1A) and 19/146 (13 %) a relevant rejection (grade ≥1B). Sensitivity, specificity, positive predictive, and negative predictive values were as follows: ER: 63 %, 78 %, 30 %, and 93 %; gRE: 63 %, 70 %, 24 %, and 93 %; LGE: 68 %, 36 %, 13 %, and 87 %; with the combination of ER and gRE with at least one out of two positive: 84 %, 57 %, 23 %, and 96 %. ROC analysis revealed an area under the curve of 0.724 for ER and 0.659 for gRE. CONCLUSION CMR parameters for myocarditis are useful to detect sub-clinical acute cellular rejection after heart transplantation. Comparable results to myocarditis can be achieved with a combination of parameters. KEY POINTS • Magnetic resonance imaging is useful for the assessment of cardiac allograft rejection. • CMR has a high negative predictive value for exclusion of allograft rejection. • Diagnostic performance is not yet good enough to replace endomyocardial biopsy.
Collapse
Affiliation(s)
- Christian Krieghoff
- Department of Diagnostic and Interventional Radiology, University Leipzig - Heart Centre, Leipzig, Germany,
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Dall’Armellina E, Ferreira V, Neubauer S. T1 Mapping in Ischemic Heart Disease. CURRENT CARDIOVASCULAR IMAGING REPORTS 2014. [DOI: 10.1007/s12410-014-9262-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
37
|
h-Ici DO, Jeuthe S, Al-Wakeel N, Berger F, Kuehne T, Kozerke S, Messroghli DR. T1 mapping in ischaemic heart disease. Eur Heart J Cardiovasc Imaging 2014; 15:597-602. [PMID: 24566951 DOI: 10.1093/ehjci/jeu024] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A unique feature of cardiac magnetic resonance is its ability to characterize myocardium. Proton relaxation times, T1, T2, and T2* are a reflection of the composition of individual tissues, and change in the presence of disease. Research into T1 mapping has largely been focused in the study of cardiomyopathies, but T1 mapping also shows huge potential in the study of ischaemic heart disease. In fact, the first cardiac T1 maps were used to characterize myocardial infarction. Robust high-resolution myocardial T1 mapping is now available for use as a clinical tool. This quantitative technique is simple to perform and analyse, minimally subjective, and highly reproducible. This review aims to summarize the present state of research on the topic, and to show the clinical potential of this method to aid the diagnosis and treatment of patients with ischaemic heart disease.
Collapse
Affiliation(s)
- Darach O h-Ici
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, Berlin 13353, Germany Division of Imaging Sciences and Biomedical Engineering, St Thomas' Hospital, 4th Floor, Lambeth Wing, Westminster Bridge Road, London SE1 7EH, UK
| | - Sarah Jeuthe
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, Berlin 13353, Germany
| | - Nadya Al-Wakeel
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, Berlin 13353, Germany
| | - Felix Berger
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, Berlin 13353, Germany
| | - Titus Kuehne
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, Berlin 13353, Germany
| | - Sebastian Kozerke
- Division of Imaging Sciences and Biomedical Engineering, St Thomas' Hospital, 4th Floor, Lambeth Wing, Westminster Bridge Road, London SE1 7EH, UK Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, Zürich 8092, Switzerland
| | - Daniel R Messroghli
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, Berlin 13353, Germany Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, Berlin 13353, Germany
| |
Collapse
|
38
|
Fernández-Jiménez R, Fernández-Friera L, Sánchez-González J, Ibáñez B. Animal Models of Tissue Characterization of Area at Risk, Edema and Fibrosis. CURRENT CARDIOVASCULAR IMAGING REPORTS 2014. [DOI: 10.1007/s12410-014-9259-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
39
|
Abstract
With the advent of thrombolytic therapy and angioplasty, it has become possible to reduce myocardial infarct size through early reperfusion. Enormous effort has been expended to find therapies that can further reduce infarct size after early intervention. Animal studies have identified many cardioprotective pathways that have the potential to reduce infarct size if activated before the onset of ischemia. More recently, interventions effective at the onset of reperfusion have been described. Although basic research has identified many targets, most has been conducted in rodent models which may not be directly applicable to human disease and even promising agents have been disappointing in large-scale clinical trials. There are many potential explanations for this failure which is the subject of this review. Potential factors include (1) the variability inherent in the patient population, whereas animal studies usually use single sex homogeneous groups maintained on standard diets in carefully controlled environments; (2) the duration of ischemia is generally shorter in animal studies, resulting in potentially more salvageable myocardium than is often the case in patients; (3) that the animals are usually young without comorbidities, whereas the patient population is generally older and has significant comorbidities; (4) animals are not treated with medications a priori, whereas the patient population is often taking medications that may affect ischemic injury; and (5) animal studies may not involve thorough assessment of effects on organs other than the heart, whereas patients can experience adverse effects of treatment in other organs that can preclude clinical use.
Collapse
Affiliation(s)
- Richard S Vander Heide
- Department of Pathology, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA.
| | | |
Collapse
|
40
|
Wince WB, Suranyi P, Schoepf UJ. Contemporary cardiovascular imaging methods for the assessment of at-risk myocardium. J Am Heart Assoc 2013; 3:e000473. [PMID: 24366853 PMCID: PMC3959708 DOI: 10.1161/jaha.113.000473] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- W Benjamin Wince
- Department of Medicine, Medical University of South Carolina Heart and Vascular Center, Medical University of South Carolina, Charleston, SC
| | | | | |
Collapse
|
41
|
Feng Y, Chen F, Ma Z, Dekeyzer F, Yu J, Xie Y, Cona MM, Oyen R, Ni Y. Towards stratifying ischemic components by cardiac MRI and multifunctional stainings in a rabbit model of myocardial infarction. Am J Cancer Res 2013; 4:24-35. [PMID: 24396513 PMCID: PMC3881225 DOI: 10.7150/thno.7188] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 09/10/2013] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES We sought to identify critical components of myocardial infarction (MI) including area at risk (AAR), MI-core and salvageable zone (SZ) by using cardiac magnetic resonance imaging (cMRI) and multifunctional stainings in rabbits. MATERIALS AND METHODS Fifteen rabbits received 90-min coronary artery (CA) ligation and reopening to induce reperfused MI. First-pass perfusion weighted imaging (PWI(90')) was performed immediately before CA reperfusion. Necrosis avid dye Evans blue (EB) was intravenously injected for later MI-core detection. One-day later, cMRI with T2-weighted imaging (T2WI), PWI(24h) and delayed enhancement (DE) T1WI was performed at a 3.0T clinical scanner. The heart was excised and CA was re-ligated with aorta infused by red-iodized-oil (RIO). The heart was sliced into 3-mm sections for digital radiography (DR), histology and planimetry with myocardial salvage index (MSI) and perfusion density rate (PDR) calculated. RESULTS There was no significant difference between MI-cores defined by DE-T1WI and EB-staining (31.13±8.55% vs 29.80±7.97%; p=0.74). The AAR was defined similarly by PWI90' (39.93±9.51%), RIO (38.82±14.41%) and DR (38.17±15.98%), underestimated by PWI(24h) (36.44±5.31%), but overestimated (p<0.01) by T2WI (56.93±8.87%). Corresponding MSI turned out to be 24.17±9.5% (PWI(90')), 21.97±9.41% (DR) and 22.68±9.65% (RIO), which were significantly (p<0.01) higher and lower than that with PWI(24h) (15.15±7.34%) and T2WI (45.52±7.5%) respectively. The PDR differed significantly (p<0.001) between normal myocardium (350.6±33.1%) and the AAR (31.2±15%), suggesting 11-times greater blood perfusion in normal myocardium over the AAR. CONCLUSION The introduced rabbit platform and new staining techniques together with the use of a 3.0T clinical scanner for cMRI enabled visualization of MI components and may contribute to translational cardiac imaging research for improved theranostic management of ischemic heart disease.
Collapse
|
42
|
Masci PG, Bogaert J. Post myocardial infarction of the left ventricle: the course ahead seen by cardiac MRI. Cardiovasc Diagn Ther 2013; 2:113-27. [PMID: 24282705 DOI: 10.3978/j.issn.2223-3652.2012.04.06] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 04/26/2012] [Indexed: 12/13/2022]
Abstract
In the last decades, cardiac magnetic resonance imaging (MRI) has gained acceptance in cardiology community as an accurate and reproducible diagnostic imaging modality in patients with ischemic heart disease (IHD). In particular, in patients with acute myocardial infarction (MI) cardiac MRI study allows a comprehensive assessment of the pattern of ischemic injury in term of reversible and irreversible damage, myocardial hemorrhage and microvascular obstruction (MVO). Myocardial salvage index, derived by quantification of myocardium (area) at risk and infarction, has become a promising surrogate end-point increasingly used in clinical trials testing novel or adjunctive reperfusion strategies. Early post-infarction, the accurate and reproducible quantification of myocardial necrosis, along with the characterization of ischemic myocardial damage in its diverse components, provides important information to predict post-infarction left ventricular (LV) remodeling, being useful for patients stratification and management. Considering its non-invasive nature, cardiac MRI suits well for investigating the time course of infarct healing and the changes occurring in peri-infarcted (adjacent) and remote myocardium, which ultimately promote the geometrical, morphological and functional abnormalities of the entire left ventricle (global LV remodeling). The current review will focus on the cardiac MRI utility for a comprehensive evaluation of patients with acute and chronic IHD with particular regard to post-infarction remodeling.
Collapse
Affiliation(s)
- Pier Giorgio Masci
- Magnetic Resonance Imaging and Cardiovascular Medicine Departments, Fondazione CNR/Regione Toscana 'G. Monasterio', Pisa, Italy
| | | |
Collapse
|
43
|
Quantitative T2 mapping for detecting myocardial edema after reperfusion of myocardial infarction: validation and comparison with T2-weighted images. Int J Cardiovasc Imaging 2013; 29 Suppl 1:65-72. [PMID: 23765068 DOI: 10.1007/s10554-013-0256-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Accepted: 06/01/2013] [Indexed: 10/26/2022]
Abstract
This study evaluates the clinical usefulness of T2 mapping for the detection of myocardial edema in the re-perfused acute myocardial infarction (MI). Cardiac MRIs were reviewed in 20 patients who had acute MI after reperfusion therapy. The regional T2 values and T2-weighted image (T2WI) signal intensities (SI) were measured in the infarcted and remote zones of the myocardium. Patients were divided into three groups according to the signal patterns of the infarcted myocardium on the T2WIs. The T2 values of the infarcted zones were compared on the T2 maps among the three groups. Validation of the T2 values was performed in the normal myocardium of seven healthy volunteers. There were no significant differences in mean T2WI-SI or T2 values in the normal myocardium of healthy volunteers compared to the remote myocardium of acute MI patients (p > 0.05). Mean SI on the T2WIs was significantly higher in the infarcted myocardium (81.3 ± 37.6) than in the remote myocardium (63.8 ± 18.1) (p < 0.05). The T2WIs showed high SI in ten patients (group 1), iso-SI in seven (group 2), and low SI in three (group 3) in the infarcted myocardium, compared to the remote myocardium. The T2 maps showed that T2 values in the infarcted myocardium had mostly increased, regardless of group, with values of 71 ± 9 ms in group 1, 64.9 ± 7.4 ms in group 2, and 61.4 ± 8.5 ms in group 3. T2 mapping is superior to T2WI for detecting areas of high SI in the infarcted myocardium. Therefore, quantitative T2 mapping sequences may be more useful and reliable in identifying myocardial edema in the infarcted myocardium than T2WI.
Collapse
|
44
|
Goldfarb JW, Hasan U, Zhao W, Han J. Magnetic resonance susceptibility weighted phase imaging for the assessment of reperfusion intramyocardial hemorrhage. Magn Reson Med 2013; 71:1210-20. [DOI: 10.1002/mrm.24747] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- James W. Goldfarb
- Department of Research and Education; Saint Francis Hospital; Roslyn New York USA
- Program in Biomedical Engineering; SUNY Stony Brook; Stony Brook New York USA
| | - Usama Hasan
- Department of Research and Education; Saint Francis Hospital; Roslyn New York USA
- New York College of Osteopathic Medicine; Old Westbury New York USA
| | - Wenguo Zhao
- Department of Research and Education; Saint Francis Hospital; Roslyn New York USA
| | - Jing Han
- Department of Research and Education; Saint Francis Hospital; Roslyn New York USA
| |
Collapse
|
45
|
Kidambi A, Mather AN, Swoboda P, Motwani M, Fairbairn TA, Greenwood JP, Plein S. Relationship between Myocardial Edema and Regional Myocardial Function after Reperfused Acute Myocardial Infarction: An MR Imaging Study. Radiology 2013; 267:701-8. [DOI: 10.1148/radiol.12121516] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
|
46
|
Eitel I, Thiele H. Cardioprotection by pre-infarct angina: training the heart to enhance myocardial salvage. Eur Heart J Cardiovasc Imaging 2013; 14:1115-6. [DOI: 10.1093/ehjci/jet093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
47
|
Shapiro BP, Mergo PJ, Austin CO, Kantor B, Gerber TC. Assessing the available techniques for testing myocardial viability: what does the future hold? Future Cardiol 2013; 8:819-36. [PMID: 23176686 DOI: 10.2217/fca.12.59] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Left ventricular dysfunction in the setting of severe coronary artery disease poses a major diagnostic and therapeutic dilemma. While this clinical scenario is generally associated with poor outcomes, some but not all patients benefit from coronary revascularization. For example, patients with severe, transmural myocardial infarctions may derive little or no functional benefit from revascularization, as the underlying myocardium is irreversibly scarred. Furthermore, these patients may be exposed to high procedural risks with a low likelihood of deriving any perceivable benefit. Conversely, hibernating myocardium reflects a substrate whereby the nonfunctioning myocytes are chronically ischemic but may be viable. Existing data are somewhat inconclusive with regard to the benefits of performing viability testing in patients with ischemic cardiomyopathy. While this testing may predict regional and global functional myocardial recovery, the ability of viability studies to predict survival and prognosis remains unproven in prospective studies to date. Yet, viability testing may still be a valuable tool to guide therapeutic options in selected patients. A variety of noninvasive viability tests are available and newer technologies, such as PET and cardiac MRI, are likely to advance the scientific field in years to come.
Collapse
Affiliation(s)
- Brian P Shapiro
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Jacksonville, FL 32224, USA.
| | | | | | | | | |
Collapse
|
48
|
Wassmuth R, Prothmann M, Utz W, Dieringer M, von Knobelsdorff-Brenkenhoff F, Greiser A, Schulz-Menger J. Variability and homogeneity of cardiovascular magnetic resonance myocardial T2-mapping in volunteers compared to patients with edema. J Cardiovasc Magn Reson 2013; 15:27. [PMID: 23537111 PMCID: PMC3627620 DOI: 10.1186/1532-429x-15-27] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 03/08/2013] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The aim of the study was to test the reproducibility and variability of myocardial T2 mapping in relation to sequence type and spatial orientation in a large group of healthy volunteers. For control T2 mapping was also applied in patients with true edema. Cardiovascular magnetic resonance (CMR) T2-mapping has potential for the detection and quantification of myocardial edema. Clinical experience is limited so far. The variability and potential pitfalls in broad application are unknown. METHODS Healthy volunteers (n = 73, 35 ± 13 years) and patients with edema (n = 28, 55 ± 17 years) underwent CMR at 1.5 T. Steady state free precession (SSFP) cine loops and T2-weighted spin echo images were obtained. In patients, additionally late gadolinium enhancement images were acquired. We obtained T2 maps in midventricular short axis (SAX) and four-chamber view (4CV) based on images with T2 preparation times of 0, 24, 55 ms and compared fast low angle shot (FLASH) and SSFP readout. 10 volunteers were scanned twice on separate days. Two observers analysed segmental and global T2 per slice. RESULTS In volunteers global myocardial T2 systematically differed depending on image orientation and sequence (FLASH 52 ± 5 vs. SSFP 55 ± 5 ms in SAX and 57 ± 6 vs. 59 ± 6 ms in 4CV; p < 0.0001 for both). Anteroseptal and apical segments had higher T2 than inferior and basal segments (SAX: 59 ± 6 vs. 48 ± 5 ms for FLASH and 59 ± 7 vs. 52 ± 4 ms for SSFP; p < 0.0001 for both). 14 volunteers had segments with T2 ≥ 70 ms. Mean intraobserver variability was 1.07 ± 1.03 ms (r = 0.94); interobserver variability was 1.6 ± 1.5 ms (r = 0.87). The coefficient of variation for repeated scans was 7.6% for SAX and 6.6% for 4CV. Mapping revealed focally increased T2 (73 ± 9 vs. 51 ± 3 ms in remote myocardium; p < 0.0001) in all patients with edema. CONCLUSIONS Myocardial T2 mapping is technically feasible and highly reproducible. It can detect focal edema and differentiate it from normal myocardium. Increased T2 was found in some volunteers most likely due to partial volume and residual motion.
Collapse
Affiliation(s)
- Ralf Wassmuth
- Department of Cardiology and Nephrology, Working Group Cardiac MRI, Humboldt University Berlin, Charite Campus Buch Experimental and Clinical Research Center and HELIOS Klinikum Berlin Buch, Berlin, Germany
| | - Marcel Prothmann
- Department of Cardiology and Nephrology, Working Group Cardiac MRI, Humboldt University Berlin, Charite Campus Buch Experimental and Clinical Research Center and HELIOS Klinikum Berlin Buch, Berlin, Germany
| | - Wolfgang Utz
- Department of Cardiology and Nephrology, Working Group Cardiac MRI, Humboldt University Berlin, Charite Campus Buch Experimental and Clinical Research Center and HELIOS Klinikum Berlin Buch, Berlin, Germany
| | - Matthias Dieringer
- Department of Cardiology and Nephrology, Working Group Cardiac MRI, Humboldt University Berlin, Charite Campus Buch Experimental and Clinical Research Center and HELIOS Klinikum Berlin Buch, Berlin, Germany
| | - Florian von Knobelsdorff-Brenkenhoff
- Department of Cardiology and Nephrology, Working Group Cardiac MRI, Humboldt University Berlin, Charite Campus Buch Experimental and Clinical Research Center and HELIOS Klinikum Berlin Buch, Berlin, Germany
| | | | - Jeanette Schulz-Menger
- Department of Cardiology and Nephrology, Working Group Cardiac MRI, Humboldt University Berlin, Charite Campus Buch Experimental and Clinical Research Center and HELIOS Klinikum Berlin Buch, Berlin, Germany
| |
Collapse
|
49
|
Dall'Armellina E. Absolute quantification of myocardial tissue composition: an additional level of complexity or an achievable clinical target? JACC Cardiovasc Imaging 2012; 5:1240-2. [PMID: 23236974 DOI: 10.1016/j.jcmg.2012.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 07/19/2012] [Indexed: 11/17/2022]
|
50
|
Croisille P, Kim HW, Kim RJ. Controversies in cardiovascular MR imaging: T2-weighted imaging should not be used to delineate the area at risk in ischemic myocardial injury. Radiology 2012; 265:12-22. [PMID: 22993217 DOI: 10.1148/radiol.12111769] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The use of T2-weighted MR imaging to delineate the area at risk and subsequently quantify myocardial salvage is problematic on many levels. The validation studies available thus far are inadequate. Unlike the data validating DE MR imaging, in which pathologic analysis has shown the precise shape and contour of the bright region exactly match the infarcted area, this level of validation does not exist for T2-weighted MR imaging. Technical advances have occurred, but image contrast between abnormal and normal regions remains limited, and in this situation, measured size differences between MR imaging data sets should not be overinterpreted. Moreover, with any T2 technique, there remains the key issue that there is no physiologic basis for the apparent T2 findings. Indeed, a homogeneously bright area at risk on T2-weighted MR images is incompatible with the known levels of edema that occur in infarcted and salvaged myocardium, and the finding that the lateral borders of T2 hyperintense regions frequently extend far beyond that of infarction is contrary to the wavefront phenomenon. Even if T2-weighted MR imaging provided an accurate measure of myocardial edema, the level of edema within the area at risk is dependent on multiple variables, including infarct size, age, reperfusion status, reperfusion injury, and therapies that could have an antiedema effect. The area at risk is a coronary perfusion territory. There is a fundamental limitation with defining the area at risk by using a nonperfusion-based indicator that can vary with different postreperfusion therapies. There are several applications for T2 myocardial imaging, including differentiation of acute from chronic MI and identification of acute myocarditis. On the basis of the currently available data; however, we conclude that T2-weighted MR imaging should not be used to delineate the area at risk in patients with ischemic myocardial injury.
Collapse
Affiliation(s)
- Pierre Croisille
- Department of Radiology, Université Jean Monnet Saint-Etienne, CREATIS, UMR CNRS 5220-INSERM U1044, Lyon, France
| | | | | |
Collapse
|