Published online before print April 10, 2006, doi: 10.1161/CIRCULATIONAHA.105.576025
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2006;113:1865-1870.)
© 2006 American Heart Association, Inc.
Imaging |
Retrospective Determination of the Area at Risk for Reperfused Acute Myocardial Infarction With T2-Weighted Cardiac Magnetic Resonance Imaging
Histopathological and Displacement Encoding With Stimulated Echoes (DENSE) Functional Validations
From the National Heart, Lung and Blood Institute, National Institutes of Heath, US Department of Health and Human Services, Bethesda, Md (A.H.A., G.S.T., A.N., L.-Y.H., F.M.G., R.F.H., A.E.A.); and Mount Sinai School of Medicine, New York, NY (A.N.).
Correspondence to Andrew Arai, MD, National Heart, Lung and Blood Institute, National Institutes of Health, Bldg 10, Room B1D416, MSC 1061, Bethesda, MD 20892-1061. E-mail AraiA{at}nhlbi.nih.gov
Received July 14, 2005; revision received January 27, 2006; accepted February 1, 2006.
Background— The aim of this study was to determine whether edema imaging by T2-weighted cardiac magnetic resonance (CMR) imaging could retrospectively delineate the area at risk in reperfused myocardial infarction. We hypothesized that the size of the area at risk during a transient occlusion would be similar to the T2-weighted hyperintense region observed 2 days later, that the T2-weighted hyperintense myocardium would show partial functional recovery after 2 months, and that the T2 abnormality would resolve over 2 months.
Methods and Results— Seventeen dogs underwent a 90-minute coronary artery occlusion, followed by reperfusion. The area at risk, as measured with microspheres (9 animals), was comparable to the size of the hyperintense zone on T2-weighted images 2 days later (43.4±3.3% versus 43.0±3.4% of the left ventricle; P=NS), and the 2 measures correlated (R=0.84). The infarcted zone was significantly smaller (23.1±3.7; both P<0.001). To test whether the hyperintense myocardium would exhibit partial functional recovery over time, 8 animals were imaged on day 2 and 2 months later. Systolic strain was mapped with displacement encoding with stimulated echoes. Edema, as detected by a hyperintense zone on T2-weighted images, resolved, and regional radial systolic strain partially improved from 4.9±0.7 to 13.1±1.5 (P=0.001) over 2 months.
Conclusions— These findings are consistent with the premise that the T2 abnormality depicts the area at risk, a zone of reversibly and irreversibly injured myocardium associated with reperfused subendocardial infarctions. The persistence of postischemic edema allows T2-weighted CMR to delineate the area at risk 2 days after reperfused myocardial infarction.
CLINICAL PERSPECTIVE
Related Articles:
-
Issue Highlights
Circulation 2006 113: 1817.[Extract] [Full Text]
- Myocardial Salvage: Retrospection, Resolution, and Radio Waves
- Dudley Pennell
Circulation 2006 113: 1821-1823.[Extract] [Full Text]
This article has been cited by other articles:
 |
|
 |
|
  T. D. Karamitsos, J. M. Francis, S. Myerson, J. B. Selvanayagam, and S. Neubauer The Role of Cardiovascular Magnetic Resonance Imaging in Heart Failure J. Am. Coll. Cardiol., October 6, 2009; 54(15): 1407 - 1424. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. W. Goldfarb, M. Roth, and J. Han Myocardial Fat Deposition after Left Ventricular Myocardial Infarction: Assessment by Using MR Water-Fat Separation Imaging Radiology, October 1, 2009; 253(1): 65 - 73. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N C Edwards, H Routledge, and R P Steeds T2-weighted magnetic resonance imaging to assess myocardial oedema in ischaemic heart disease Heart, August 15, 2009; 95(16): 1357 - 1361. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Gomez, B. Li, N. Mewton, I. Sanchez, C. Piot, M. Elbaz, and M. Ovize Inhibition of mitochondrial permeability transition pore opening: translation to patients Cardiovasc Res, July 15, 2009; 83(2): 226 - 233. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Tsujioka, T. Imanishi, H. Ikejima, A. Kuroi, S. Takarada, T. Tanimoto, H. Kitabata, K. Okochi, Y. Arita, K. Ishibashi, et al. Impact of Heterogeneity of Human Peripheral Blood Monocyte Subsets on Myocardial Salvage in Patients With Primary Acute Myocardial Infarction. J. Am. Coll. Cardiol., July 7, 2009; 54(2): 130 - 138. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Wright, T. Adriaenssens, S. Dymarkowski, W. Desmet, and J. Bogaert Quantification of Myocardial Area at Risk With T2-Weighted CMR: Comparison With Contrast-Enhanced CMR and Coronary Angiography J. Am. Coll. Cardiol. Img., July 1, 2009; 2(7): 825 - 831. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Abdel-Aty Myocardial Edema Imaging of the Area at Risk in Acute Myocardial Infarction: Seeing Through Water J. Am. Coll. Cardiol. Img., July 1, 2009; 2(7): 832 - 834. [Full Text] [PDF]
|
|
|
|
 |
|
 D. P. O'Regan, R. Ahmed, C. Neuwirth, Y. Tan, G. Durighel, J. V. Hajnal, I. Nadra, S. J. Corbett, and S. A. Cook Cardiac MRI of myocardial salvage at the peri-infarct border zones after primary coronary intervention Am J Physiol Heart Circ Physiol, July 1, 2009; 297(1): H340 - H346. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Carlsson, J. F.A. Ubachs, E. Hedstrom, E. Heiberg, S. Jovinge, and H. Arheden Myocardium at risk after acute infarction in humans on cardiac magnetic resonance quantitative assessment during follow-up and validation with single-photon emission computed tomography. J. Am. Coll. Cardiol. Img., May 1, 2009; 2(5): 569 - 576. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. G. Friedrich A closer look on the battlefield the salvaged area at risk as an outcome marker for myocardial reperfusion. J. Am. Coll. Cardiol. Img., May 1, 2009; 2(5): 577 - 579. [Full Text] [PDF]
|
|
|
|
|
|
M. G. Friedrich, U. Sechtem, J. Schulz-Menger, G. Holmvang, P. Alakija, L. T. Cooper, J. A. White, H. Abdel-Aty, M. Gutberlet, S. Prasad, et al. Cardiovascular magnetic resonance in myocarditis: A JACC White Paper. J. Am. Coll. Cardiol., April 28, 2009; 53(17): 1475 - 1487. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Abdel-Aty, M. Cocker, C. Meek, J. V. Tyberg, and M. G. Friedrich Edema as a very early marker for acute myocardial ischemia a cardiovascular magnetic resonance study. J. Am. Coll. Cardiol., April 7, 2009; 53(14): 1194 - 1201. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. J. Klocke Emerging applications of t(2)-weighted cardiac magnetic resonance imaging in acute ischemic syndromes. J. Am. Coll. Cardiol., April 7, 2009; 53(14): 1202 - 1203. [Full Text] [PDF]
|
|
|
|
 |
|
 T. Lockie, E. Nagel, S. Redwood, and S. Plein Use of Cardiovascular Magnetic Resonance Imaging in Acute Coronary Syndromes Circulation, March 31, 2009; 119(12): 1671 - 1681. [Full Text] [PDF]
|
|
|
|
|
|
D. P. O'Regan, R. Ahmed, N. Karunanithy, C. Neuwirth, Y. Tan, G. Durighel, J. V. Hajnal, I. Nadra, S. J. Corbett, and S. A. Cook Reperfusion Hemorrhage Following Acute Myocardial Infarction: Assessment with T2* Mapping and Effect on Measuring the Area at Risk Radiology, March 1, 2009; 250(3): 916 - 922. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. C. Wu Fighting the "Fire" of Myocardial Reperfusion Injury: How to Define Success? J. Am. Coll. Cardiol., February 24, 2009; 53(8): 730 - 731. [Full Text] [PDF]
|
|
|
|
|
|
H. Thiele, J. Friedenberger, I. Eitel, G. Furnau, E. Grebe, S. Erbs, A. Linke, S. Mobius-Winkler, G. Schuler, K. Schindler, et al. Response to Letter Regarding Article, "Intracoronary Compared With Intravenous Bolus Abciximab Application in Patients With ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention" Circulation, January 27, 2009; 119(3): e20 - e20. [Full Text] [PDF]
|
|
|
|
 |
|
 M.-T. Wu, M.-Y. M. Su, Y.-L. Huang, K.-R. Chiou, P. Yang, H.-B. Pan, T. G. Reese, V. J. Wedeen, and W.-Y. I. Tseng Sequential Changes of Myocardial Microstructure in Patients Postmyocardial Infarction by Diffusion-Tensor Cardiac MR: Correlation With Left Ventricular Structure and Function Circ Cardiovasc Imaging, January 1, 2009; 2(1): 32 - 40. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Engblom, E. Hedstrom, E. Heiberg, G. S. Wagner, O. Pahlm, and H. Arheden Rapid Initial Reduction of Hyperenhanced Myocardium After Reperfused First Myocardial Infarction Suggests Recovery of the Peri-Infarction Zone: One-Year Follow-Up by MRI Circ Cardiovasc Imaging, January 1, 2009; 2(1): 47 - 55. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. G. Friedrich Tissue characterization of acute myocardial infarction and myocarditis by cardiac magnetic resonance. J. Am. Coll. Cardiol. Img., September 1, 2008; 1(5): 652 - 662. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. E. Arai Using Magnetic Resonance Imaging to Characterize Recent Myocardial Injury: Utility in Acute Coronary Syndrome and Other Clinical Scenarios Circulation, August 19, 2008; 118(8): 795 - 796. [Full Text] [PDF]
|
|
|
|
|
|
H. Thiele, K. Schindler, J. Friedenberger, I. Eitel, G. Furnau, E. Grebe, S. Erbs, A. Linke, S. Mobius-Winkler, D. Kivelitz, et al. Intracoronary Compared With Intravenous Bolus Abciximab Application in Patients With ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: The Randomized Leipzig Immediate Percutaneous Coronary Intervention Abciximab IV Versus IC in ST-Elevation Myocardial Infarction Trial Circulation, July 1, 2008; 118(1): 49 - 57. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Davidson Can the Off-Pump Coronary Artery Bypass Debate Shed Light on Postoperative Right Heart Dysfunction? Circulation, April 29, 2008; 117(17): 2181 - 2183. [Full Text] [PDF]
|
|
|
|
|
|
M. G. Friedrich, H. Abdel-Aty, A. Taylor, J. Schulz-Menger, D. Messroghli, and R. Dietz The salvaged area at risk in reperfused acute myocardial infarction as visualized by cardiovascular magnetic resonance. J. Am. Coll. Cardiol., April 22, 2008; 51(16): 1581 - 1587. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Thibault, C. Piot, P. Staat, L. Bontemps, C. Sportouch, G. Rioufol, T. T. Cung, E. Bonnefoy, D. Angoulvant, J.-F. Aupetit, et al. Long-Term Benefit of Postconditioning Circulation, February 26, 2008; 117(8): 1037 - 1044. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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]
|
|
|
|
|
|
R. G Assomull, D. J Pennell, and S. K Prasad Cardiovascular magnetic resonance in the evaluation of heart failure Heart, August 1, 2007; 93(8): 985 - 992. [Full Text] [PDF]
|
|
|
|
 |
|
 J. T. Ortiz-Perez, S. N. Meyers, D. C. Lee, P. Kansal, F. J. Klocke, T. A. Holly, C. J. Davidson, R. O. Bonow, and E. Wu Angiographic estimates of myocardium at risk during acute myocardial infarction: validation study using cardiac magnetic resonance imaging Eur. Heart J., July 2, 2007; 28(14): 1750 - 1758. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. L. Gerber Risk area, infarct size, and the exposure of the wavefront phenomenon of myocardial necrosis in humans Eur. Heart J., July 2, 2007; 28(14): 1670 - 1672. [Full Text] [PDF]
|
|
|
|
|
|
B. Ibanez, S. Prat-Gonzalez, W. S. Speidl, G. Vilahur, A. Pinero, G. Cimmino, M. J. Garcia, V. Fuster, J. Sanz, and J. J. Badimon Early Metoprolol Administration Before Coronary Reperfusion Results in Increased Myocardial Salvage: Analysis of Ischemic Myocardium at Risk Using Cardiac Magnetic Resonance Circulation, June 12, 2007; 115(23): 2909 - 2916. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. G. Assomull, J. C. Lyne, N. Keenan, A. Gulati, N. H. Bunce, S. W. Davies, D. J. Pennell, and S. K. Prasad The role of cardiovascular magnetic resonance in patients presenting with chest pain, raised troponin, and unobstructed coronary arteries Eur. Heart J., May 3, 2007; (2007) ehm113v1. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Pennell Myocardial Salvage: Retrospection, Resolution, and Radio Waves Circulation, April 18, 2006; 113(15): 1821 - 1823. [Full Text] [PDF]
|
|