(Circulation. 1999;99:36-43.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Functional Recovery of Subepicardial Myocardial Tissue in Transmural Myocardial Infarction After Successful Reperfusion
An Important Contribution to the Improvement of Regional and Global Left Ventricular Function
Presented in part at the 69th Scientific Sessions of the American Heart Association, New Orleans, La, November 10–13, 1996, and published in abstract form (Circulation. 1996;94[suppl I]:I-244).
From the Departments of Radiology (J.B., H.B., G.M.), Nuclear Medicine (A.M., J.N., L.M.), and Cardiology (F.V.d.W., M.-C.H., W.D., F.E.R.), Gasthuisberg University Hospital, Leuven, Belgium.
Correspondence to Frank Rademakers, MD, PhD, Department of Cardiology, Gasthuisberg University Hospital, University of Leuven, Herestraat 49, B-3000 Leuven, Belgium.
Background—The transmural extent of myocardial necrosis after an acute coronary artery occlusion can vary considerably. The contribution of residual subepicardial viable myocardium to global left ventricular function is largely unknown.
Methods and Results—We studied 12 patients with single-vessel disease 1 week after successful reperfusion of a first transmural anterior myocardial infarction (MI). With PET, myocardial blood flow (MBF) and glucose metabolism were measured regionally, and the viability was graded as normal, mismatch, or match with severely (<50% of normal) or intermediately (50% to 80% of normal) impaired MBF. Magnetic resonance tagging was used to regionally quantify fiber strains, wall thickening, and ejection fraction in patients 1 week and 3 months after the MI and in age-matched healthy volunteers. From 1 week to 3 months, subepicardial fiber shortening improved significantly in the match region (MBF <50%, -5.1±7.0% to -9.9±8.7%; MBF of 50% to 80%, -7.1±7.6% to -14.9±7.9%). This was associated with an improvement in regional ejection fraction in the infarcted myocardium (29.6±21.8% to 43.5±15.5%, P<0.0001) and in normal regions (54.3±15.1% to 56.5±13.1%, P=0.013), contributing to an increase in global ejection fraction from 44.2±22.2% to 49.3±17.9% (P<0.0001).
Conclusions—Functional recovery of viable subepicardial regions is a mechanism of late improvement in regional and global ejection fraction after a so-called transmural MI.
Key Words: myocardial infarction • magnetic resonance imaging • tomography • reperfusion
This article has been cited by other articles:
 |
|
 |
|
  F. A. Blyakhman, A. M. Naidich, S. G. Kolchanova, S. Yu. Sokolov, Y. V. Kremleva, and V. V. Chestukhin Validity of ejection fraction as a measure of myocardial functional state: impact of asynchrony Eur J Echocardiogr, July 1, 2009; 10(5): 613 - 618. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. G. Masci, S. Dymarkowski, F. E. Rademakers, and J. Bogaert Determination of Regional Ejection Fraction in Patients with Myocardial Infarction by Using Merged Late Gadolinium Enhancement and Cine MR: Feasibility Study Radiology, January 1, 2009; 250(1): 50 - 60. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Figueras, O. Alcalde, J. A. Barrabes, V. Serra, J. Alguersuari, J. Cortadellas, and R.-M. Lidon Changes in Hospital Mortality Rates in 425 Patients With Acute ST-Elevation Myocardial Infarction and Cardiac Rupture Over a 30-Year Period Circulation, December 16, 2008; 118(25): 2783 - 2789. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. Dor, F. Civaia, C. Alexandrescu, and F. Montiglio The post-myocardial infarction scarred ventricle and congestive heart failure: the preeminence of magnetic resonance imaging for preoperative, intraoperative, and postoperative assessment. J. Thorac. Cardiovasc. Surg., December 1, 2008; 136(6): 1405 - 1412. [Full Text] [PDF]
|
|
|
|
 |
|
 T. Vartdal, H. Brunvand, E. Pettersen, H.-J. Smith, E. Lyseggen, T. Helle-Valle, H. Skulstad, H. Ihlen, and T. Edvardsen Early Prediction of Infarct Size by Strain Doppler Echocardiography After Coronary Reperfusion J. Am. Coll. Cardiol., April 24, 2007; 49(16): 1715 - 1721. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y Abe, T Muro, Y Sakanoue, R Komatsu, M Otsuka, T Naruko, A Itoh, M Yoshiyama, K Haze, and J Yoshikawa Intravenous myocardial contrast echocardiography predicts regional and global left ventricular remodelling after acute myocardial infarction: comparison with low dose dobutamine stress echocardiography Heart, December 1, 2005; 91(12): 1578 - 1583. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Koyama, H. Matsuoka, T. Mochizuki, H. Higashino, H. Kawakami, S. Nakata, J. Aono, T. Ito, M. Naka, Y. Ohashi, et al. Assessment of Reperfused Acute Myocardial Infarction with Two-Phase Contrast-enhanced Helical CT: Prediction of Left Ventricular Function and Wall Thickness Radiology, June 1, 2005; 235(3): 804 - 811. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Menicanti and M. Di Donato Surgical left ventricle reconstruction, pathophysiologic insights, results and expectation from the STICH trial Eur. J. Cardiothorac. Surg., December 1, 2004; 26(Suppl_1): S42 - S47. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. N. Mazzadi, M. F. Janier, B. Brossier, X. Andre-Fouet, D. Revel, and P. Croisille Tagged MRI and PET in severe CAD: discrepancy between preoperative inotropic reserve and intramyocardial functional outcome after revascularization Am J Physiol Heart Circ Physiol, November 1, 2004; 287(5): H2226 - H2233. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. B. Selvanayagam, A. Kardos, J. M. Francis, F. Wiesmann, S. E. Petersen, D. P. Taggart, and S. Neubauer Value of Delayed-Enhancement Cardiovascular Magnetic Resonance Imaging in Predicting Myocardial Viability After Surgical Revascularization Circulation, September 21, 2004; 110(12): 1535 - 1541. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Jérôm. Garot The study of diastole by tagged MRI: are we nearly there yet? Eur. Heart J., August 2, 2004; 25(16): 1376 - 1377. [Full Text] [PDF]
|
|
|
|
|
|
A. N. Mazzadi, M. F. Janier, B. Brossier, X. Andre-Fouet, E. McFadden, D. Revel, and P. Croisille Dobutamine-tagged MRI for inotropic reserve assessment in severe CAD: relationship with PET findings Am J Physiol Heart Circ Physiol, May 1, 2004; 286(5): H1946 - H1953. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. C. Wu and J. A.C. Lima Noninvasive Imaging of Myocardial Viability: Current Techniques and Future Developments Circ. Res., December 12, 2003; 93(12): 1146 - 1158. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. A. Smiseth and H. Ihlen Strain rate imaging: why do we need it? J. Am. Coll. Cardiol., November 5, 2003; 42(9): 1584 - 1586. [Full Text] [PDF]
|
|
|
|
|
|
J. A. C. Lima Myocardial viability assessment by contrast-enhanced magnetic resonance imaging J. Am. Coll. Cardiol., September 3, 2003; 42(5): 902 - 904. [Full Text] [PDF]
|
|
|
|
|
|
G. D. Buckberg Congestive heart failure: Treat the disease, not the symptom--return to normalcy J. Thorac. Cardiovasc. Surg., March 1, 2003; 125(90030): S41 - 49. [Full Text] [PDF]
|
|
|
|
 |
|
 F. Rademakers, F. Van de Werf, L. Mortelmans, G. Marchal, and J. Bogaert Evolution of regional performance after an acute anterior myocardial infarction in humans using magnetic resonance tagging J. Physiol., February 1, 2003; 546(3): 777 - 787. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. L. Gerber, J. Garot, D. A. Bluemke, K. C. Wu, and J. A.C. Lima Accuracy of Contrast-Enhanced Magnetic Resonance Imaging in Predicting Improvement of Regional Myocardial Function in Patients After Acute Myocardial Infarction Circulation, August 27, 2002; 106(9): 1083 - 1089. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Maes, P. Mertens, and G.R. Sutherland What is the role of cardiac PET in patients with ischaemic heart disease and significant left ventricular dysfunction? Eur. Heart J., September 2, 2001; 22(18): 1629 - 1631. [PDF]
|
|
|
|
|
|
B. L. Gerber, C. E. Rochitte, D. A. Bluemke, J. A. Melin, P. Crosille, L. C. Becker, and J. A.C. Lima Relation Between Gd-DTPA Contrast Enhancement and Regional Inotropic Response in the Periphery and Center of Myocardial Infarction Circulation, August 28, 2001; 104(9): 998 - 1004. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. D. Buckberg Congestive heart failure: Treat the disease, not the symptom--Return to normalcy J. Thorac. Cardiovasc. Surg., April 1, 2001; 121(4): 628 - 637. [Full Text] [PDF]
|
|
|
|
|
|
M. J. W. Gotte, A. C. van Rossum, J. W. R. Twisk, J. P. A. Kuijer, J. T. Marcus, and C. A. Visser Quantification of regional contractile function after infarction: strain analysis superior to wall thickening analysis in discriminating infarct from remote myocardium J. Am. Coll. Cardiol., March 1, 2001; 37(3): 808 - 817. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Saeed, G. Lund, M. F. Wendland, J. Bremerich, H.-J. Weinmann, and C. B. Higgins Magnetic Resonance Characterization of the Peri-Infarction Zone of Reperfused Myocardial Infarction With Necrosis-Specific and Extracellular Nonspecific Contrast Media Circulation, February 13, 2001; 103(6): 871 - 876. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Bogaert and F. E. Rademakers Regional nonuniformity of normal adult human left ventricle Am J Physiol Heart Circ Physiol, February 1, 2001; 280(2): H610 - H620. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W.-Y. I. Tseng, T. G. Reese, R. M. Weisskoff, T. J. Brady, and V. J. Wedeen Myocardial Fiber Shortening in Humans: Initial Results of MR Imaging Radiology, July 1, 2000; 216(1): 128 - 139. [Abstract] [Full Text]
|
|
|
|
|
|
J. Bogaert, H. Bosmans, A. Maes, P. Suetens, G. Marchal, and F. E. Rademakers Remote myocardial dysfunction after acute anterior myocardial infarction: impact of left ventricular shape on regional function: A magnetic resonance myocardial tagging study J. Am. Coll. Cardiol., May 1, 2000; 35(6): 1525 - 1534. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Colonna, R. Montisci, L. Galiuto, L. Meloni, and S. Iliceto Effects of Acute Myocardial Ischemia on Intramyocardial Contraction Heterogeneity : A Study Performed with Ultrasound Integrated Backscatter During Transesophageal Atrial Pacing Circulation, October 26, 1999; 100(17): 1770 - 1776. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. K. Lund, C. B. Higgins, M. F. Wendland, N. Watzinger, H.-J. Weinmann, and M. Saeed Assessment of Nicorandil Therapy in Ischemic Myocardial Injury by Using Contrast-enhanced and Functional MR Imaging Radiology, December 1, 2001; 221(3): 676 - 682. [Abstract] [Full Text] [PDF]
|
|