Abstract 20303: Characterization of the Peri-Infarct Zone by Contrast-Enhanced Magnetic Resonance Imaging and 18F-FDG Positron Emission Tomography and its Clinical Impact in Patients with Coronary Artery Disease
Introduction: Recent studies emphasizing the prognostic value of the peri-infarct zone have used different CMR methods for quantification of the peri-infarct zone. None of these studies has validated quantification of the peri-infarct zone by CMR using the gold standard for assessing myocardial vitality, 18F-FDG positron emission tomography (PET).
Methods: A total of 52 patients with coronary artery disease were investigated by late-gadolinum CMR (1.5 T-scanner) and 18F-FDG PET. Glucose uptake 50% to >60% signal intensity (SI) of the maximal SI, and of the peri-infarct zone, which varied in SI between 40% and 60% of the maximal SI were validated against 18F-FDG-PET. In addition, clinical characteristics and five-year outcomes of the patients were assessed.
Results: Defining the infarct core zone as the region with a SI >50% of the maximum SI and the peri-infarct zone as 40–50% of the maximum SI allowed for a excellent characterization of the infarct and peri-infarct zones by CMR with a high correlation for both the infarct zone (r=0.535; p<0.0001) and peri-infarct zone (r=0.599; p<0.0001) to the 18F-FDG PET. The extent of the peri-infarct zone, was strongly associated with arterial hypertension (p=0.025), as well as with increased CK enzyme levels (p=0.0001) and the presence of hibernating myocardium, both assesed at the time point of myocardial infarction (p=0.045); no association was seen with the presence of a large infarct core, infarct transmurality or with segmental function analysis. Patients with a larger peri-infarct zone showed a trend towards worse outcome (p=0.062), including myocardial infarction, revascularization by PCI and hospitalization due to heart failure, within a five-year follow-up period.
Conclusions: CMR late gadolinum enhancement imaging allows for a valid quantification of the peri-infarct zone in patients with coronary artery disease. The extent of the peri-infarct zone is influenced by different clinical factors and associated with a worse five-year outcome.
- © 2010 by American Heart Association, Inc.