Published online before print August 5, 2002, doi: 10.1161/01.CIR.0000026394.01888.18
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(Circulation. 2002;106:957.)
© 2002 American Heart Association, Inc.
Clinical Investigation and Reports |
Assessing Myocardial Viability and Infarct Transmurality With Left Ventricular Electromechanical Mapping in Patients With Stable Coronary Artery Disease
Validation by Delayed-Enhancement Magnetic Resonance Imaging
From the Departments of Adult Cardiology and Radiology, Texas Heart Institute/St Luke’s Episcopal Hospital and Baylor College of Medicine, Houston, Tex, and Philips Medical Systems, North America, Bothell, Wash.
Correspondence to Emerson C. Perin, MD, 6624 Fannin, Suite 2220, Houston, TX 77030. E-mail eperin{at}crescentb.net
Background— This study was designed to define myocardial viability and establish practical cut-off values for differentiating normal myocardial tissue from subendocardial and transmural scar tissue by using electromechanical mapping (EMM). We validated our results by delayed-enhancement cardiac MRI (DE-MRI).
Methods and Results— We prospectively studied 15 ambulatory patients with stable coronary disease who were candidates for cardiac catheterization. Within 48 hours of EMM, DE-MRI was performed. Using EMM software, we created a bull’s eye precisely matched to that generated by DE-MRI. Segment by segment, we compared the MRI results to the corresponding unipolar voltage value for that same segment in the EMM bull’s eye. Of 300 total segments, 275 were compared. The segments were divided into normal (n=211), subendocardial scar (n=49), and transmural scar (n=15). We found that subendocardial (6.8±2.9 mV) and transmural (4.6±1.9 mV) scar segments had significantly less unipolar voltage than normal (11.6±4.5 mV) segments (P<0.05 for each comparison). When normal myocardium was compared with myocardium with subendocardial scar, the threshold for differentiating between the two areas was 7.9 mV (sensitivity, 80%; specificity, 80%). Comparison of normal tissue to transmural scar yielded a threshold of 6.9 mV (sensitivity, 93%; specificity, 88%).
Conclusions— Our results demonstrate that normal myocardium can be accurately distinguished from myocardium with subendocardial or transmural infarcts on the basis of unipolar voltage values obtained through EMM. This is the first study to validate these results by using cardiac DE-MRI in humans.
Key Words: coronary disease • magnetic resonance imaging • myocardium
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