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(Circulation. 2004;110:3457-3464.)
© 2004 American Heart Association, Inc.

Imaging

Assessment of Myocardial Viability by Intracellular ²³Na Magnetic Resonance Imaging

From the University Medical Center (M.A.J., J.G.V.E., C.J.A.V.E.), Heart Lung Center Utrecht, NMR Laboratory, and the Interuniversity Cardiology Institute of the Netherlands (M.A.J., J.G.V.E., M.G.J.N.), Utrecht, the Netherlands.

Correspondence to Cees J.A. Van Echteld, PhD, FESC, Heidelberglaan 100, Rm G02.523, PO Box 85500, 3508 GA Utrecht, The Netherlands. E-mail c.j.a.vanechteld{at}hli.azu.nl

Received June 24, 2004; revision received August 19, 2004; accepted August 26, 2004.

Background— Because of rapid changes in myocardial intracellular Na⁺ (Na⁺_i) during ischemia and reperfusion (R), ²³Na magnetic resonance imaging (MRI) appears to be an ideal diagnostic modality for early detection of myocardial ischemia and viability. So far, cardiac ²³Na MRI data are limited and mostly concerned with imaging of total Na⁺. For proper interpretation, imaging of both Na⁺_i and extracellular Na⁺ is essential. In this study, we tested whether Na⁺_i imaging can be used to assess viability after low-flow (LF) ischemia.

Methods and Results— Isolated rat hearts were subjected to LF (1%, 2%, or 3% of control coronary flow) and R. A shift reagent was used to separate Na⁺_i and extracellular Na⁺ resonances. Acquisition-weighted ²³Na chemical shift imaging (CSI) was alternated with ²³Na MR spectroscopy. Already during control perfusion, Na⁺_i could be clearly seen on the images. Na⁺_i image intensity increased with increasing severity of ischemia. During R, Na⁺_i image intensity remained highest in 1% LF hearts. Not only did we find very good correlations between Na⁺_i image intensity at end-R and end-diastolic pressure (R=0.85, P<0.001) and recovery of the rate-pressure product (R=–0.88, P<0.001) at end-R, but most interestingly, also Na⁺_i image intensity at end-LF was well correlated with end-diastolic pressure (R=0.78, P<0.01) and with recovery of the rate-pressure product (R=–0.81, P<0.01) at end-R. Furthermore, Na⁺_i image intensity at end-LF was well correlated with creatine kinase release during R (R=0.79, P<0.05) as well as with infarct size (R=0.77, P<0.05).

Conclusions— These data indicate that ²³Na CSI is a promising tool for the assessment of myocardial viability.

Key Words: magnetic resonance imaging • myocardium • ischemia • sodium • reperfusion

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