(Circulation. 1998;98:2687-2694.)
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports |
Contrast Magnetic Resonance Imaging in the Assessment of Myocardial Viability in Patients With Stable Coronary Artery Disease and Left Ventricular Dysfunction
From the Departments of Medicine, Radiology, and Biomedical Engineering and the Feinberg Cardiovascular Research Institute, Northwestern University Medical School, Chicago, Ill.
Correspondence to Robert O. Bonow, MD, Wesley 524, Northwestern University Medical School, 250 E Superior St, Chicago, IL 60611-3008. E-mail r-bonow{at}nwu.edu
Background—The utility of contrast MRI for assessing myocardial viability in stable coronary artery disease (CAD) with left ventricular dysfunction is uncertain. We therefore performed cine and contrast MRI in 24 stable patients with CAD and regional contractile abnormalities and compared MRI findings with rest-redistribution 201Tl imaging and dobutamine echocardiography.
Methods and Results—Delayed MRI contrast enhancement patterns
were examined from 3 to 15 minutes after injection of 0.1 mmol/kg
IV gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA). Comparable
MRI and 201Tl basal and midventricular
short-axis images were subdivided into 6 segments. Segments judged
nonviable by quantitative and qualitative assessment of
201Tl scans showed persistent, systematically greater MRI
contrast signal intensity than segments judged viable
(P
0.002). Delayed contrast hyperenhancement also
occurred in segments judged nonviable by dobutamine
echocardiography (P0.03). The
presence or absence of hyperenhancement correlated most closely with
nonviability and viability, respectively, in segments that were
akinetic or dyskinetic under resting conditions (83% concordance with
201Tl in both cases). In segments with resting hypokinesis,
58% of segments showing hyperenhancement were judged viable by
201Tl and may have represented an admixture of
scar tissue and viable myocardium.
Conclusions—Delayed (by 3 to 15 minutes) hyperenhancement of Gd-DTPA contrast–enhanced MRI images occurs frequently in dysfunctional areas of the left ventricle in patients with stable CAD. Hyperenhancement is associated with nonviability by rest-redistribution 201Tl scintigraphy and dobutamine echocardiography, particularly in regions exhibiting resting akinesis/dyskinesis. The absence of hyperenhancement correlates with radionuclide and echocardiographic determinations of viability, regardless of resting contractile function.
Key Words: coronary disease • echocardiography • heart failure • magnetic resonance imaging
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