(Circulation. 2000;102:1678.)
© 2000 American Heart Association, Inc.
Basic Science Reports |
Early Assessment of Myocardial Salvage by Contrast-Enhanced Magnetic Resonance Imaging
From the Northwestern University Medical School Feinberg Cardiovascular Research Institute (H.B.H, R.J.K., M.A.P., D.S.F., R.M.J.), Departments of Medicine (R.J.K., M.A.P., R.M.J.), and Biomedical Engineering (R.M.J.), Chicago, Ill.
Correspondence to Robert M. Judd, PhD, Feinberg Cardiovascular Research Institute, Northwestern University Medical School, 303 East Chicago Ave, Tarry 12–723, Chicago, IL 60611-3008. E-mail rjudd{at}nwu.edu
Background—Myocardial salvage after acute myocardial infarction is defined clinically by early restoration of flow and long-term improvement in contractile function. We hypothesized that contrast-enhanced magnetic resonance imaging (MRI), performed early after myocardial infarction, indexes myocardial salvage. We studied the relationship between the transmural extent of hyperenhancement by contrast-enhanced MRI, restoration of flow, and recovery of function.
Methods and Results—The left anterior descending coronary artery was occluded in dogs (n=15) for either 45 minutes, 90 minutes, or permanently. Cine and contrast-enhanced MRI were performed 3 days after the procedure; cine MRI was also done 10 and 28 days after the procedure. The transmural extent of hyperenhancement and wall thickening were determined using a 60-segment model. The mean transmural extent of hyperenhancement for the 45-minute occlusion group was 22% of the 90-minute group and 18% of the permanent occlusion group (P<0.05 for both). The transmural extent of hyperenhancement on day 3 was related to future improvement in both wall thickening score and absolute wall thickening at 10 and 28 days (P<0.0001 for each). For example, of the 415 segments on day 3 that were dysfunctional and had <25% transmural hyperenhancement, 362 (87%) improved by day 28. Conversely, no segments (0 of 9) with 100% hyperenhancement improved. The transmural extent of hyperenhancement on day 3 was a better predictor of improvement in contractile function than occlusion time (P<0.0001).
Conclusions—A reduction in the transmural extent of hyperenhancement by contrast-enhanced MRI early after myocardial infarction is associated with an early restoration of flow and future improvement in contractile function.
Key Words: magnetic resonance imaging • contrast media • myocardial infarction • salvage therapy
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