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(Circulation. 2006;114:8-10.)
© 2006 American Heart Association, Inc.

Editorial

"Shades of Gray" in Cardiac Magnetic Resonance Images of Infarcted Myocardium

Can They Tell Us What We’d Like Them to?

Francis J. Klocke, MD; Edwin Wu, MD; Daniel C. Lee, MD

From the Feinberg Cardiovascular Research Institute and Department of Medicine (Division of Cardiology), Feinberg School of Medicine, Northwestern University, Chicago, Ill.

Correspondence to Francis J. Klocke, MD, Tarry 12-703, Feinberg School of Medicine, Northwestern University, 303 East Chicago Avenue, Chicago, IL 60611-3008. E-mail f-klocke@northwestern.edu

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

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Identifying individuals at risk of sudden death continues to be a challenging problem. Subgroups classified as high risk on the basis of prior myocardial infarction, low ejection fraction, and arrhythmia-related parameters are recognized to include only a small proportion of the sudden cardiac deaths occurring annually.¹ Nevertheless, as the indications for implantable cardioverter-defibrillators expand to intermediate-risk groups, issues related to cost and the potential morbidity of implantable cardioverter-defibrillator implantation take on greater significance.

Article p 32

The possibility that high-resolution cardiac magnetic resonance imaging (CMR) of acute and chronic infarctions with the use of delayed gadolinium enhancement² can improve risk stratification is now being evaluated by several groups. Bello et al³ have reported that measurements of infarct mass and surface area predict inducible monomorphic ventricular tachycardia more reliably than ejection fraction does in coronary patients referred for electrophysiological study. Because of the known limitation in positive predictive accuracy of electrophysiological testing,⁴ a need remains for studies of more definitive outcomes. Although CMR measurements of infarct size have also been used to forecast the extent of functional recovery after acute infarction and myocardial revascularization, studies of their predictive value for mortality are just beginning to become available.

The study of Yan et al⁵ in this issue provides an initial look at the mortality question. It proposes a new approach for identifying a "potentially arrhythmic heterogeneous zone of viable and nonviable peri-infarct myocardium." The authors hypothesize that the size of this zone can provide prognostic value for mortality incremental to that offered . . . [Full Text of this Article]

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