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(Circulation. 1998;98:634-641.)
© 1998 American Heart Association, Inc.

Clinical Investigation and Reports

Myocardial Tissue Characterization After Acute Myocardial Infarction With Wavelet Image Decomposition

A Novel Approach for the Detection of Myocardial Viability in the Early Postinfarction Period

Aleksandar N. Neskovi, MD; Aleksandra Mojsilovi, PhD; Tomislav Jovanovi, MD, PhD; Jovan Vasiljevi, MD, PhD; Miodrag Popovi, PhD; Jelena Marinkovi, PhD; Milovan Boji, MD, PhD; ; Aleksandar D. Popovi, MD, PhD, FESC

From the Cardiovascular Research Center, Dedinje Cardiovascular Institute, Belgrade University Medical School (A.N.N., J.M., M.B., A.D.P.); Belgrade University Faculty of Electrical Engineering (A.M., M.P.); and the Institutes of Physiology (T.J.) and Pathology (J.V.), Belgrade University Medical School, Belgrade, Yugoslavia.

Correspondence to Aleksandar D. Popovi, MD, PhD, FESC, FACC, Cardiovascular Research Center, Dedinje Cardiovascular Institute, Milana Tepica 1, 11040 Belgrade, Yugoslavia. E-mail epopoval{at}ubbg.etf.bg.ac.yu

Background—Only a few texture measures can be used for texture characterization of infarcted myocardium and detection of reperfused myocardium early after infarction. This study was conducted to establish the relationship between texture properties of infarcted myocardium and infarct-related artery patency by quantitative computer analysis of 2-dimensional echocardiographic images with the wavelet-based method for texture characterization, evaluate the relationship between texture properties and myocardial viability, and correlate histopathologic changes after experimental infarction with the texture measures.

Methods and Results—We analyzed 2-dimensional transthoracic echocardiographic images in 18 patients at different time points after infarction using the wavelet transform method. Regional wall motion of infarcted segments was analyzed on a follow-up echocardiographic study obtained 6 months after infarction. To verify the accuracy of the proposed texture measure and energy difference cutoff value, we prospectively evaluated another group of 19 patients. In addition, histopathologic changes in 9 dogs with experimental infarction were correlated with the texture measures. Sensitivity, specificity, and accuracy of the wavelet method for detection of reperfusion in the study group were 73%, 86%, and 78%, respectively, on day 2; 91%, 86%, and 89%, at 1 week; and 100%, 100%, and 100% at 3 weeks. Among 9 patients with improvement in regional wall motion on a follow-up study, 7 on day 2, 8 at 1 week, and 9 at 3 weeks were classified into the reperfused group by the wavelet method. Histopathologic features associated with the classification of reperfusion by the wavelet method were infarct transmurality (P=0.024) and degree of necrosis (P=0.028).

Conclusions—Our clinical and experimental data suggest that the wavelet method can be used to differentiate between viable myocardium with recovery potential and definite myocardial necrosis in the early postinfarction period.

Key Words: myocardial infarction • reperfusion • tissue

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