(Circulation. 1999;100:1992-2002.)
© 1999 American Heart Association, Inc.
Basic Science Reports |
Relationship of MRI Delayed Contrast Enhancement to Irreversible Injury, Infarct Age, and Contractile Function
From Northwestern University Medical School Feinberg Cardiovascular Research Institute (R.J.K., D.S.F., T.B.P., K.H., E.-L.C., J.P.F., F.J.K., R.M.J.), Departments of Medicine (R.J.K., F.J.K.), Radiology (T.B.P., J.P.F.), and Biomedical Engineering (D.S.F., F.J.K., R.M.J.), and Siemens Medical Systems (O.S., J.B.), Chicago, Ill.
Correspondence to Robert M. Judd, PhD, Feinberg Cardiovascular Research Institute, Northwestern University Medical School, 303 E Chicago Ave, Tarry 12-723, Chicago, IL 60611-3008. E-mail rjudd{at}nwu.edu
Background—Contrast MRI enhancement patterns in several pathophysiologies resulting from ischemic myocardial injury are controversial or have not been investigated. We compared contrast enhancement in acute infarction (AI), after severe but reversible ischemic injury (RII), and in chronic infarction.
Methods and Results—In dogs, a large coronary artery was occluded to study AI and/or chronic infarction (n=18), and a second coronary artery was chronically instrumented with a reversible hydraulic occluder and Doppler flowmeter to study RII (n=8). At 3 days after surgery, cine MRI revealed reduced wall thickening in AI (5±6% versus 33±6% in normal, P<0.001). In RII, wall thickening before, during, and after inflation of the occluder for 15 minutes was 35±5%, 1±8%, and 21±10% and Doppler flow was 19.8±5.3, 0.2±0.5, and 56.3±17.7 (peak hyperemia) cm/s, respectively, confirming occlusion, transient ischemia, and reperfusion. Gd-DTPA–enhanced MR images acquired 30 minutes after contrast revealed hyperenhancement of AI (294±96% of normal, P<0.001) but not of RII (98±6% of normal, P=NS). Eight weeks later, the chronically infarcted region again hyperenhanced (253±54% of normal, n=8, P<0.001). High-resolution (0.5x0.5x0.5 mm) ex vivo MRI demonstrated that the spatial extent of hyperenhancement was the same as the spatial extent of myocyte necrosis with and without reperfusion at 1 day (R=0.99, P<0.001) and 3 days (R=0.99, P<0.001) and collagenous scar at 8 weeks (R=0.97, P<0.001).
Conclusions—In the pathophysiologies investigated, contrast MRI distinguishes between reversible and irreversible ischemic injury independent of wall motion and infarct age.
Key Words: magnetic resonance imaging • myocardial infarction • ischemia
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U Sechtem, H Mahrholdt, and H Vogelsberg Cardiac magnetic resonance in myocardial disease Heart, December 1, 2007; 93(12): 1520 - 1527. [Abstract] [Full Text] [PDF]
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J. F Younger, S. Plein, J. Barth, J. P Ridgway, S. G Ball, and J. P Greenwood Troponin-I concentration 72 h after myocardial infarction correlates with infarct size and presence of microvascular obstruction Heart, December 1, 2007; 93(12): 1547 - 1551. [Abstract] [Full Text] [PDF]
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V. R. S. Fernandes, K. C. Wu, B. D. Rosen, A. Schmidt, A. C. Lardo, N. Osman, H. R. Halperin, G. Tomaselli, R. Berger, D. A. Bluemke, et al. Enhanced Infarct Border Zone Function and Altered Mechanical Activation Predict Inducibility of Monomorphic Ventricular Tachycardia in Patients with Ischemic Cardiomyopathy Radiology, December 1, 2007; 245(3): 712 - 719. [Abstract] [Full Text] [PDF]
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K. Thygesen, J. S. Alpert, H. D. White, and on behalf of the Joint ESC/ACCF/AHA/WHF Task Force Universal Definition of Myocardial Infarction J. Am. Coll. Cardiol., November 27, 2007; 50(22): 2173 - 2195. [Full Text] [PDF]
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J. B. Selvanayagam, P. N. Hawkins, B. Paul, S. G. Myerson, and S. Neubauer Evaluation and Management of the Cardiac Amyloidosis J. Am. Coll. Cardiol., November 27, 2007; 50(22): 2101 - 2110. [Abstract] [Full Text] [PDF]
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K. Thygesen, J. S. Alpert, H. D. White, on behalf of the Joint ESC/ACCF/AHA/WHF Task Force, TASK FORCE MEMBERS: Chairpersons: Kristian Thygese, Biomarker Group: Allan S. Jaffe, Coordinator (USA), ECG Group: Bernard Chaitman, Co-ordinator (USA), P, Imaging Group: Richard Underwood, Coordinator (UK), Intervention Group: Jean-Pierre Bassand, Co-ordina, Clinical Investigation Group: Paul W. Armstrong, C, et al. Universal Definition of Myocardial Infarction Circulation, November 27, 2007; 116(22): 2634 - 2653. [Full Text] [PDF]
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W. D. Gilson, F. H. Epstein, Z. Yang, Y. Xu, K.-M. R. Prasad, M.-C. Toufektsian, V. E. Laubach, and B. A. French Borderzone Contractile Dysfunction Is Transiently Attenuated and Left Ventricular Structural Remodeling Is Markedly Reduced Following Reperfused Myocardial Infarction in Inducible Nitric Oxide Synthase Knockout Mice J. Am. Coll. Cardiol., October 30, 2007; 50(18): 1799 - 1807. [Abstract] [Full Text] [PDF]
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Task Force Members, K. Thygesen, J. S. Alpert, H. D. White, Biomarker Group, A. S. Jaffe, F. S. Apple, M. Galvani, H. A. Katus, L. K. Newby, et al. Universal definition of myocardial infarction: Kristian Thygesen, Joseph S. Alpert and Harvey D. White on behalf of the Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction Eur. Heart J., October 2, 2007; 28(20): 2525 - 2538. [Full Text] [PDF]
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J. D. Dodd, G. Holmvang, U. Hoffmann, M. Ferencik, S. Abbara, T. J. Brady, and R. C. Cury Quantification of Left Ventricular Noncompaction and Trabecular Delayed Hyperenhancement with Cardiac MRI: Correlation with Clinical Severity Am. J. Roentgenol., October 1, 2007; 189(4): 974 - 980. [Abstract] [Full Text] [PDF]
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A. Jacquier, C. B. Higgins, A. J. Martin, L. Do, D. Saloner, and M. Saeed Injection of Adeno-associated Viral Vector Encoding Vascular Endothelial Growth Factor Gene in Infarcted Swine Myocardium: MR Measurements of Left Ventricular Function and Strain Radiology, October 1, 2007; 245(1): 196 - 205. [Abstract] [Full Text] [PDF]
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J. W. Goldfarb, S. Arnold, and J. Han Recent Myocardial Infarction: Assessment with Unenhanced T1-weighted MR Imaging Radiology, October 1, 2007; 245(1): 245 - 250. [Abstract] [Full Text] [PDF]
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T. N. Martin, B. A. Groenning, H. M. Murray, T. Steedman, J. E. Foster, A. T. Elliot, H. J. Dargie, R. H. Selvester, O. Pahlm, and G. S. Wagner ST-Segment Deviation Analysis of the Admission 12-Lead Electrocardiogram as an Aid to Early Diagnosis of Acute Myocardial Infarction With a Cardiac Magnetic Resonance Imaging Gold Standard J. Am. Coll. Cardiol., September 11, 2007; 50(11): 1021 - 1028. [Abstract] [Full Text] [PDF]
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