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(Circulation. 1999;99:727-729.)
© 1999 American Heart Association, Inc.

Editorial

Prediction of Myocardial Viability by MRI

Charles B. Higgins, MD

Correspondence to Charles B. Higgins, MD, Professor and Vice Chairman of Radiology, Department of Radiology, Box 0628, 505 Parnassus Ave, Suite L308, San Francisco, CA 94143-0618. E-mail charles.higgins@radiology.ucsf.edu

Key Words: Editorials • magnetic resonance imaging • contrast media • reperfusion

Revascularization interventions in evolving myocardial infarctions have their rationale in the assumption that viable myocardial cells persist in the ischemically injured area. Consequently, intensive work has been directed over the past decade toward the development of noninvasive imaging methods to identify and quantify myocardial viability.

In this regard, the temporal pattern of myocardial contrast enhancement on MRI is reported in this issue of Circulation to be a predictive index of potential myocardial viability for reperfused myocardial infarctions.¹ With fast MRI, the first-pass distribution of MRI contrast media indicated that despite patency of the target coronary artery with TIMI 3 flow in all patients, reperfusion at the tissue level was impeded in more than half of the injured regions. This sign of impeded perfusion ("no-reflow" phenomenon) was predictive of poorer contractile recovery 7 weeks after the acute event. These results are similar to earlier reports, such as that of Ito et al,² that used myocardial contrast echocardiography to assess myocardial reperfusion after patency of acutely occluded epicardial coronary arteries was established. Recovery of regional and global LV function was worse in the group of patients with residual contrast defects. MRI and echocardiographic estimates of tissue perfusion after coronary recanalization seem to reflect the severity of microvascular disruption, occlusion, or extravascular compression by edema or hemorrhage. Thus, the depicted perfusion pattern serves as a surrogate of the severity of myocardial injury rather than a direct indicator of myocardial cellular viability.

A number of other promising MRI techniques for predicting myocardial viability of . . . [Full Text of this Article]

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