Abstract 19366: First-in-Human Dual Manganese- and Gadolinium-Enhanced Cardiac MRI Delineates the Peri-Infarct Region in Patients with Severe Ischemic Cardiomyopathy
Background: Delayed Gadolinium (Gd) Enhancement MRI (DEMRI) overestimates infarct size. Manganese enters only live, active cells, and its T1 signal is specific to live cardiomyocytes. We combined DEMRI and Manganese-enhanced MRI (MEMRI) in humans with ischemic cardiomyopathy to test if MEMRI provides unique infarct characterization.
Methods: 5 patients with ejection fraction (EF) <45%, Class I-III ischemic CHF, were enrolled (5 male, age 63±3 years). 2 cardiac MRIs (Signa 3THDx, 8-channel cardiac coil, GE HealthCare) were done for left ventricular (LV) function & DEMRI (day 0) and MEMRI (day 7). DEMRI: 10-20min after 0.2 mmol/kg intravenous Gd (Magnevist, Bayer HealthCare, Germany). MEMRI: 20-40min after 1mmol/kg intravenous SeeMore™ manganese (Eagle Vision Pharmaceutical Corp). Image analysis: (CMR42, Circle CV Imaging Inc) LV volumes traced semi-automatically; infarct volumes obtained using >3 standard deviations (SDs) above mean (DEMRI) and >2 SDs below mean (MEMRI signal defect = scar). % Infarct to total LV mass was calculated.
Results: LV EF=32±4% (mean±SD). DEMRI volumes (39±11%* of LV) were significantly (*p<0.01) greater than MEMRI defect volumes (16±3% of LV). Peri-Infarct Region with intermediate signal-to-noise ratio (SNR) was significantly (p<0.05) lower than remote zone MEMRI SNR (n=7 matched slices of DEMRI/MEMRI in 5 pts).
Conclusion: The DEMRI-MEMRI infarct size discrepancy may delineate a peri-infarct region, or “at-risk myocardium” that DEMRI does not detect.
Author Disclosures: R. Dash: None. Y. Matsuura: None. P.J. Kim: None. H. Shiran: None. P. Harnish: Employment; Significant; Eagle Vision Pharmaceutical Corporation. M.V. McConnell: Other Research Support; Modest; GE Healthcare. P.C. Yang: None.
- © 2014 by American Heart Association, Inc.