Published online before print April 10, 2006, doi: 10.1161/CIRCULATIONAHA.105.576025
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(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.
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