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Jeyaprakash P, Pathan F, Ozawa K, Robledo KP, Shah KK, Morton RL, Yu C, Madronio C, Hallani H, Loh H, Boyle A, Ford TJ, Porter TR, Negishi K. Restoring microvascular circulation with diagnostic ultrasound and contrast agent: rationale and design of the REDUCE trial. Am Heart J 2024; 275:163-172. [PMID: 38944262 DOI: 10.1016/j.ahj.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 06/22/2024] [Accepted: 06/22/2024] [Indexed: 07/01/2024]
Abstract
OBJECTIVES This study aims to evaluate the efficacy and cost-effectiveness of sonothrombolysis delivered pre and post primary percutaneous coronary intervention (pPCI) on infarct size assessed by cardiac MRI, in patients presenting with STEMI, when compared against sham procedure. BACKGROUND More than a half of patients with successful pPCI have significant microvascular obstruction and residual infarction. Sonothrombolysis is a therapeutic use of ultrasound with contrast enhancement that may improve microcirculation and infarct size. The benefits and real time physiological effects of sonothrombolysis in a multicentre setting are unclear. METHODS The REDUCE (Restoring microvascular circulation with diagnostic ultrasound and contrast agent) trial is a prospective, multicentre, patient and outcome blinded, sham-controlled trial. Patients presenting with STEMI will be randomized to one of 2 treatment arms, to receive either sonothrombolysis treatment or sham echocardiography before and after pPCI. This tailored design is based on preliminary pilot data from our centre, showing that sonothrombolysis can be safely delivered, without prolonging door to balloon time. Our primary endpoint will be infarct size assessed on day 4±2 on Cardiac Magnetic Resonance (CMR). Patients will be followed up for 6 months post pPCI to assess secondary endpoints. Sample size calculations indicate we will need 150 patients recruited in total. CONCLUSIONS This multicentre trial will test whether sonothrombolysis delivered pre and post primary PCI can improve patient outcomes and is cost-effective, when compared with sham ultrasound delivered with primary PCI. The results from this trial may provide evidence for the utilization of sonothrombolysis as an adjunct therapy to pPCI to improve cardiovascular outcomes in STEMI. ANZ Clinical Trial Registration number: ACTRN 12620000807954.
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Affiliation(s)
- Prajith Jeyaprakash
- Faculty of Medicine and Health, Charles Perkins Centre Nepean, Sydney Medical School Nepean, The University of Sydney, New South Wales, Australia; Department of Cardiology, Nepean Hospital, Sydney, New South Wales, Australia
| | - Faraz Pathan
- Faculty of Medicine and Health, Charles Perkins Centre Nepean, Sydney Medical School Nepean, The University of Sydney, New South Wales, Australia; Department of Cardiology, Nepean Hospital, Sydney, New South Wales, Australia; Department of Radiology, Nepean Hospital, Sydney, New South Wales, Australia
| | - Koya Ozawa
- Faculty of Medicine and Health, Charles Perkins Centre Nepean, Sydney Medical School Nepean, The University of Sydney, New South Wales, Australia; Department of Cardiology, Nepean Hospital, Sydney, New South Wales, Australia
| | - Kristy P Robledo
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Karan K Shah
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Christopher Yu
- Faculty of Medicine and Health, Charles Perkins Centre Nepean, Sydney Medical School Nepean, The University of Sydney, New South Wales, Australia; Department of Cardiology, Nepean Hospital, Sydney, New South Wales, Australia
| | - Christine Madronio
- Faculty of Medicine and Health, Charles Perkins Centre Nepean, Sydney Medical School Nepean, The University of Sydney, New South Wales, Australia
| | - Hisham Hallani
- Faculty of Medicine and Health, Charles Perkins Centre Nepean, Sydney Medical School Nepean, The University of Sydney, New South Wales, Australia; Department of Cardiology, Nepean Hospital, Sydney, New South Wales, Australia
| | - Han Loh
- Department of Radiology, Nepean Hospital, Sydney, New South Wales, Australia
| | - Andrew Boyle
- Department of Cardiology, John Hunter Hospital, Newcastle, New South Wales, Australia; University of Newcastle, New South Wales, Australia
| | - Thomas J Ford
- University of Newcastle, New South Wales, Australia; Department of Cardiology, Gosford Public Hospital, Gosford, New South Wales, Australia
| | - Thomas R Porter
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Kazuaki Negishi
- Faculty of Medicine and Health, Charles Perkins Centre Nepean, Sydney Medical School Nepean, The University of Sydney, New South Wales, Australia; Department of Cardiology, Nepean Hospital, Sydney, New South Wales, Australia.
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Sun Z, Zhang Q, Zhao H, Yan C, Yang HJ, Li D, Li K, Liu Z, Yang Q, Dharmakumar R. Retrospective assessment of at-risk myocardium in reperfused acute myocardial infarction patients using contrast-enhanced balanced steady-state free-precession cardiovascular magnetic resonance at 3T with SPECT validation. J Cardiovasc Magn Reson 2021; 23:25. [PMID: 33715636 PMCID: PMC7958470 DOI: 10.1186/s12968-021-00730-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 01/20/2021] [Accepted: 02/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Contrast-enhanced (CE) steady-state free precession (SSFP) CMR at 1.5T has been shown to be a valuable alternative to T2-based methods for the detection and quantifications of area-at-risk (AAR) in acute myocardial infarction (AMI) patients. However, CE-SSFP's capacity for assessment of AAR at 3T has not been investigated. We examined the clinical utility of CE-SSFP and T2-STIR for the retrospective assessment of AAR at 3T with single-photon-emission-computed tomography (SPECT) validation. MATERIALS AND METHODS A total of 60 AMI patients (ST-elevation AMI, n = 44; non-ST-elevation AMI, n = 16) were recruited into the CMR study between 3 and 7 days post revascularization. All patients underwent T2-STIR, CE-bSSFP and late-gadolinium-enhancement CMR. For validation, SPECT images were acquired in a subgroup of patients (n = 30). RESULTS In 53 of 60 patients (88 %), T2-STIR was of diagnostic quality compared with 54 of 60 (90 %) with CE-SSFP. In a head-to-head per-slice comparison (n = 365), there was no difference in AAR quantified using T2-STIR and CE-SSFP (R2 = 0.92, p < 0.001; bias:-0.4 ± 0.8 cm2, p = 0.46). On a per-patient basis, there was good agreement between CE-SSFP (n = 29) and SPECT (R2 = 0.86, p < 0.001; bias: - 1.3 ± 7.8 %LV, p = 0.39) for AAR determination. T2-STIR also showed good agreement with SPECT for AAR measurement (R2 = 0.81, p < 0.001, bias: 0.5 ± 11.1 %LV, p = 0.81). There was also a strong agreement between CE-SSFP and T2-STIR with respect to the assessment of AAR on per-patient analysis (R2 = 0.84, p < 0.001, bias: - 2.1 ± 10.1 %LV, p = 0.31). CONCLUSIONS At 3T, both CE-SSFP and T2-STIR can retrospectively quantify the at-risk myocardium with high accuracy.
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Affiliation(s)
- Zheng Sun
- Department of Radiology, Xuanwu Hospital, Capital Medical University, 100053, Beijing, China
| | - Qiuhang Zhang
- Department of Radiology, Xuanwu Hospital, Capital Medical University, 100053, Beijing, China
| | - Huan Zhao
- Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Chengxi Yan
- Department of Radiology, Xuanwu Hospital, Capital Medical University, 100053, Beijing, China
| | - Hsin-Jung Yang
- Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, CA, 90048, USA
- Department of Medicine, University of California in Los Angeles, Los Angeles, CA, 90095, USA
| | - Kuncheng Li
- Department of Radiology, Xuanwu Hospital, Capital Medical University, 100053, Beijing, China
| | - Zhi Liu
- Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
| | - Qi Yang
- Department of Radiology, Xuanwu Hospital, Capital Medical University, 100053, Beijing, China.
| | - Rohan Dharmakumar
- Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, CA, 90048, USA
- Department of Medicine, University of California in Los Angeles, Los Angeles, CA, 90095, USA
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Rysz S, Lundberg J, Nordberg P, Eriksson H, Wieslander B, Lundin M, Fyrdahl A, Pernow J, Ugander M, Djärv T, Jonsson Fagerlund M. The effect of levosimendan on survival and cardiac performance in an ischemic cardiac arrest model - A blinded randomized placebo-controlled study in swine. Resuscitation 2020; 150:113-120. [PMID: 32234367 DOI: 10.1016/j.resuscitation.2020.02.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/03/2020] [Accepted: 02/27/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Survival after out-of-hospital cardiac arrest remains poor. Levosimendan could be a new intervention in this setting. Therefore, we conducted a blinded, placebo controlled randomized study investigating the effects of levosimendan on survival and cardiac performance in an ischemic cardiac arrest model in swine. METHODS Twenty-four anesthetised swines underwent experimentally-induced acute myocardial infarction and ventricular fibrillation. At the start of CPR, a bolus dose of levosimendan (12 μg kg-1) or placebo was given followed by a 24-h infusion (0.2 μg kg-1 min-1) after return of spontaneously circulation. Animals were evaluated by risk of death, post-resuscitation hemodynamics and infarction size by magnetic resonance imaging (MRI) up to 32 h post arrest. RESULTS Spontaneous circulation was restored in all (12/12) animals in the levosimendan group compared to two thirds (8/12) in the placebo group (P = 0.09). Protocol survival was higher for the levosimendan group (P = 0.02) with an estimated 88% lower risk of death compared to placebo (hazard ratio [95% confidence interval] 0.12 [0.01-0.96], P = 0.046). Cardiac output (CO) recovered 40% faster during the first hour of the intensive care period for the levosimendan group (difference 0.13 [0.01-0.26] L min-1P = 0.04). The placebo group required higher inotropic support during the intensive care period which masked an even bigger recovery in CO in the levosimendan group (58%). The MRI showed no difference in myocardial scar size or in myocardial area at risk. CONCLUSIONS Levosimendan given intra-arrest and during the first 24-h of post-resuscitation care improved survival and cardiac performance in this ischemic cardiac arrest model. Institutional Protocol Number; KERIC 5.2.18-14933.
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Affiliation(s)
- Susanne Rysz
- Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
| | - Johan Lundberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Per Nordberg
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Helen Eriksson
- Stockholm University Demography Unit, Department of Sociology, Stockholm University, Sweden
| | - Björn Wieslander
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
| | - Magnus Lundin
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
| | - Alexander Fyrdahl
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
| | - John Pernow
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Heart and Vascular Theme, Karolinska University Hospital, Sweden
| | - Martin Ugander
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden; Kolling Institute, Royal North Shore Hospital, and Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Therese Djärv
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Function Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Malin Jonsson Fagerlund
- Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden; Department of Physiology and Pharmacology, Karolinska Institutet, Sweden
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Hansen ESS, Pedersen SF, Pedersen SB, Bøtker HE, Kim WY. Validation of contrast enhanced cine steady-state free precession and T2-weighted CMR for assessment of ischemic myocardial area-at-risk in the presence of reperfusion injury. Int J Cardiovasc Imaging 2019; 35:1039-1045. [DOI: 10.1007/s10554-019-01569-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 02/21/2019] [Indexed: 11/27/2022]
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Göransson C, Ahtarovski KA, Kyhl K, Lønborg J, Nepper-Christensen L, Bertelsen L, Ghotbi AA, Schoos MM, Køber L, Høfsten D, Helqvist S, Kelbæk H, Engstrøm T, Vejlstrup N. Assessment of the myocardial area at risk: comparing T2-weighted cardiovascular magnetic resonance imaging with contrast-enhanced cine (CE-SSFP) imaging—a DANAMI3 substudy. Eur Heart J Cardiovasc Imaging 2018; 20:361-366. [DOI: 10.1093/ehjci/jey106] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 05/01/2018] [Accepted: 07/04/2018] [Indexed: 12/16/2022] Open
Affiliation(s)
- Christoffer Göransson
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Kiril Aleksov Ahtarovski
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Kasper Kyhl
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Jacob Lønborg
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Lars Nepper-Christensen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Litten Bertelsen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Adam Ali Ghotbi
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Mikkel Malby Schoos
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Dan Høfsten
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Steffen Helqvist
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Henning Kelbæk
- Department of Cardiology, Zealand University Hospital, Sygehusvej 10, Roskilde, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
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De Palma R, Sörensson P, Verouhis D, Pernow J, Saleh N. Quantification of myocardium at risk in ST- elevation myocardial infarction: a comparison of contrast-enhanced steady-state free precession cine cardiovascular magnetic resonance with coronary angiographic jeopardy scores. J Cardiovasc Magn Reson 2017; 19:55. [PMID: 28750637 PMCID: PMC5530997 DOI: 10.1186/s12968-017-0359-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 05/03/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Clinical outcome following acute myocardial infarction is predicted by final infarct size evaluated in relation to left ventricular myocardium at risk (MaR). Contrast-enhanced steady-state free precession (CE-SSFP) cardiovascular magnetic resonance imaging (CMR) is not widely used for assessing MaR. Evidence of its utility compared to traditional assessment methods and as a surrogate for clinical outcome is needed. METHODS Retrospective analysis within a study evaluating post-conditioning during ST elevation myocardial infarction (STEMI) treated with coronary intervention (n = 78). CE-SSFP post-infarction was compared with angiographic jeopardy methods. Differences and variability between CMR and angiographic methods using Bland-Altman analyses were evaluated. Clinical outcomes were compared to MaR and extent of infarction. RESULTS MaR showed correlation between CE-SSFP, and both BARI and APPROACH scores of 0.83 (p < 0.0001) and 0.84 (p < 0.0001) respectively. Bias between CE-SSFP and BARI was 1.1% (agreement limits -11.4 to +9.1). Bias between CE-SSFP and APPROACH was 1.2% (agreement limits -13 to +10.5). Inter-observer variability for the BARI score was 0.56 ± 2.9; 0.42 ± 2.1 for the APPROACH score; -1.4 ± 3.1% for CE-SSFP. Intra-observer variability was 0.15 ± 1.85 for the BARI score; for the APPROACH score 0.19 ± 1.6; and for CE-SSFP -0.58 ± 2.9%. CONCLUSION Quantification of MaR with CE-SSFP imaging following STEMI shows high correlation and low bias compared with angiographic scoring and supports its use as a reliable and practical method to determine myocardial salvage in this patient population. TRIAL REGISTRATION Clinical trial registration information for the parent clinical trial: Karolinska Clinical Trial Registration (2008) Unique identifier: CT20080014. Registered 04th January 2008.
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Affiliation(s)
- Rodney De Palma
- Karolinska Institutet, Department of Medicine, Unit of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Peder Sörensson
- Karolinska Institutet, Department of Medicine, Unit of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Dinos Verouhis
- Karolinska Institutet, Department of Medicine, Unit of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - John Pernow
- Karolinska Institutet, Department of Medicine, Unit of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Nawzad Saleh
- Karolinska Institutet, Department of Medicine, Unit of Cardiology, Karolinska University Hospital, Stockholm, Sweden
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Sandfort V, Kwan AC, Elumogo C, Vigneault DM, Symons R, Pourmorteza A, Rice K, Davies-Venn C, Ahlman MA, Liu CY, Zimmerman SL, Bluemke DA. Automatic high-resolution infarct detection using volumetric multiphase dual-energy CT. J Cardiovasc Comput Tomogr 2017; 11:288-294. [PMID: 28442244 DOI: 10.1016/j.jcct.2017.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 03/31/2017] [Accepted: 04/15/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Late contrast enhancement CT (LCE-CT) visualizes the presence of myocardial infarcts. Differentiation of the contrast-enhanced infarct from blood pool is challenging. We developed a novel method using data from first pass CT angiography (CTA) imaging to enable automatic infarct detection. MATERIALS AND METHODS A canine model of myocardial infarction was produced in 11 animals. Two months later, first pass CTA (90 kVp) and LCE-CT (dual energy 90 kVp/150 kVp tin filtered) were performed. Late gadolinium enhancement MRI was used as reference standard. The CTA and LCE-CT were co-registered using a fully automatic non-rigid method based on curved B-splines. The method allowed for limited elastic deformation and the considerable differences in attenuation between first-pass and delayed image. The blood pool was easily identified on the CTA image by high attenuation. Because CTA and LCE-CT were registered, the blood pool segmentation can be directly transferred to the LCE-CT - thereby solving the key problem of infarct/blood pool differentiation. The remaining segmentation of infarcted vs. noninfarcted myocardium was performed using a threshold. Automatic and MRI-guided expert segmentations of LCE-CT infarcts were compared to each other on volume and area basis (intraclass correlation coefficient, ICC) and on voxel basis (dice similarity coefficient, DSC between automatic and expert CT segmentation). CT infarct volumes were compared with the reference standard MRI. RESULTS The infarcts were mainly subendocardial (81%) and relatively small (median MRI infarct mass 7.4 g). The automatic segmentation showed excellent agreement with expert segmentation on volume and area measurements (ICC = 0.96 and 0.87, respectively). DSC showed moderately good agreement (DSC = 0.47). Compared to MRI there was modest agreement (ICC = 0.62) and excellent correlation (R = 0.9). Manual interaction was less than 1 min per exam. CONCLUSION We propose an automatic method for infarct segmentation on LCE-CT using multiphase CT information, which showed excellent agreement with expert readers and favorable correlation with MRI.
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Affiliation(s)
- Veit Sandfort
- Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Alan C Kwan
- The Johns Hopkins Hospital, Department of Medicine, Baltimore, MD, USA
| | - Comfort Elumogo
- Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Davis M Vigneault
- Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Rolf Symons
- Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Amir Pourmorteza
- Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Kelly Rice
- ORS Division of Veterinary Resources, National Institutes of Health, Bethesda, MD, USA
| | - Cynthia Davies-Venn
- Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Mark A Ahlman
- Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Chia-Ying Liu
- Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, MD, USA
| | | | - David A Bluemke
- Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, MD, USA.
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Mangion K, Corcoran D, Carrick D, Berry C. New perspectives on the role of cardiac magnetic resonance imaging to evaluate myocardial salvage and myocardial hemorrhage after acute reperfused ST-elevation myocardial infarction. Expert Rev Cardiovasc Ther 2016; 14:843-54. [PMID: 27043975 DOI: 10.1586/14779072.2016.1173544] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Cardiac magnetic resonance (CMR) imaging enables the assessment of left ventricular function and pathology. In addition to established contrast-enhanced methods for the assessment of infarct size and microvascular obstruction, other infarct pathologies, such as myocardial edema and myocardial hemorrhage, can be identified using innovative CMR techniques. The initial extent of myocardial edema revealed by T2-weighted CMR has to be stable for edema to be taken as a retrospective marker of the area-at-risk, which is used to calculate myocardial salvage. The timing of edema assessment is important and should be focused within 2 - 7 days post-reperfusion. Some recent investigations have called into question the diagnostic validity of edema imaging after acute STEMI. Considering the results of these studies, as well as results from our own laboratory, we conclude that the time-course of edema post-STEMI is unimodal, not bimodal. Myocardial hemorrhage is the final consequence of severe vascular injury and a progressive and prognostically important complication early post-MI. Myocardial hemorrhage is a therapeutic target to limit reperfusion injury and infarct size post-STEMI.
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Affiliation(s)
- Kenneth Mangion
- a BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences , University of Glasgow , Glasgow , UK.,b West of Scotland Regional Heart & Lung Centre , Golden Jubilee National Hospital , Clydebank , UK
| | - David Corcoran
- a BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences , University of Glasgow , Glasgow , UK.,b West of Scotland Regional Heart & Lung Centre , Golden Jubilee National Hospital , Clydebank , UK
| | - David Carrick
- a BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences , University of Glasgow , Glasgow , UK.,b West of Scotland Regional Heart & Lung Centre , Golden Jubilee National Hospital , Clydebank , UK
| | - Colin Berry
- a BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences , University of Glasgow , Glasgow , UK.,b West of Scotland Regional Heart & Lung Centre , Golden Jubilee National Hospital , Clydebank , UK
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