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Singh JA, Woodard PK, Dávila-Román VG, Waggoner AD, Gutierrez FR, Zheng J, Eisen SA. Cardiac magnetic resonance imaging abnormalities in systemic lupus erythematosus: a preliminary report. Lupus 2016; 14:137-44. [PMID: 15751818 DOI: 10.1191/0961203305lu2050oa] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The purpose of this prospective, pilot study was to determine whether differences in myocardial T2 relaxivity can be identified among active systemic lupus erythematosus (SLE) patients with clinically suspected SLE myocarditis, other active SLE patients, inactive SLE patients and age and gender matched controls. Eleven consecutive female patients (six with active SLE and five with inactive SLE), and five age, gender and race matched healthy controls underwent imaging with echocardiography and cardiac magnetic resonance imaging (MRI). Echocardiographic measurements included left ventricular end diastolic (LVEDV) and end systolic volumes (LVESV), and mass (LVM) (all indexed to body mass); ejection fraction and cardiac output. The cardiac MRI measurement was the T2 relaxation time (an index of soft tissue signal, with higher levels suggestive of increased tissue water content). Patients with active SLE had significantly higher LVEDVand LVM than inactive SLE patients and healthy controls, and significantly larger LVESV than healthy controls. Myocardial T2 relaxation times were significantly higher in patients with active SLE compared to those with inactive SLE and to healthy controls, and remained higher even after excluding the two active SLE patients who had clinical myocarditis. The four active SLE patients who underwent repeat cardiac imaging studies after clinical improvement showed normalization of these myocardial abnormalities. The conclusion was that active SLE patients demonstrate abnormalities in myocardial structure manifested by high myocardial T2 relaxation times that normalized after clinical improvement in disease activity. These findings suggest that T2 relaxation values are a sensitive indicator of myocardial disease in patients with SLE and that myocardial T2 relaxation abnormality frequently occur in patients with active SLE, even in the absence of myocardial involvement by clinical criteria.
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Affiliation(s)
- J A Singh
- Rheumatology Division, Washington University School of Medicine, St Louis, MO, USA.
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Impacts of nicorandil on infarct myocardium in comparison with nitrate: assessed by cardiac magnetic resonance imaging. Heart Vessels 2015; 31:1430-7. [DOI: 10.1007/s00380-015-0752-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 09/25/2015] [Indexed: 10/22/2022]
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Witschey WRT, Zsido GA, Koomalsingh K, Kondo N, Minakawa M, Shuto T, McGarvey JR, Levack MM, Contijoch F, Pilla JJ, Gorman JH, Gorman RC. In vivo chronic myocardial infarction characterization by spin locked cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2012; 14:37. [PMID: 22704222 PMCID: PMC3461454 DOI: 10.1186/1532-429x-14-37] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 06/15/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Late gadolinium enhanced (LGE) cardiovascular magnetic resonance (CMR) is frequently used to evaluate myocardial viability, estimate total infarct size and transmurality, but is not always straightforward is and contraindicated in patients with renal failure because of the risk of nephrogenic systemic fibrosis. T2- and T1-weighted CMR alone is however relatively insensitive to chronic myocardial infarction (MI) in the absence of a contrast agent. The objective of this manuscript is to explore T1ρ-weighted rotating frame CMR techniques for infarct characterization without contrast agents. We hypothesize that T1ρ CMR accurately measures infarct size in chronic MI on account of a large change in T1ρ relaxation time between scar and myocardium. METHODS 7Yorkshire swine underwent CMR at 8 weeks post-surgical induction of apical or posterolateral myocardial infarction. Late gadolinium enhanced and T1ρ CMR were performed at high resolution to visualize MI. T1ρ-weighted imaging was performed with a B₁ = 500 Hz spin lock pulse on a 3 T clinical MR scanner. Following sacrifice, the heart was excised and infarct size was calculated by optical planimetry. Infarct size was calculated for all three methods (LGE, T1ρ and planimetry) and statistical analysis was performed. T1ρ relaxation time maps were computed from multiple T1ρ-weighted images at varying spin lock duration. RESULTS Mean infarct contrast-to-noise ratio (CNR) in LGE and T1ρ CMR was 2.8 ± 0.1 and 2.7 ± 0.1. The variation in signal intensity of tissues was found to be, in order of decreasing signal intensity, LV blood, fat and edema, infarct and healthy myocardium. Infarct size measured by T1ρ CMR (21.1% ± 1.4%) was not significantly different from LGE CMR (22.2% ± 1.5%) or planimetry (21.1% ± 2.7%; p < 0.05).T1ρ relaxation times were T1ρinfarct = 91.7 ms in the infarct and T1ρremote = 47.2 ms in the remote myocardium. CONCLUSIONS T1ρ-weighted imaging using long spin locking pulses enables high discrimination between infarct and myocardium. T1ρ CMR may be useful to visualizing MI without the need for exogenous contrast agents for a wide range of clinical cardiac applications such as to distinguish edema and scar tissue and tissue characterization of myocarditis and ventricular fibrosis.
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Affiliation(s)
- Walter RT Witschey
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, University of Pennsylvania, 500 S Ridgeway Ave, Glenolden, PA 19036, USA
| | - Gerald A Zsido
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Kevin Koomalsingh
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Norihiro Kondo
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Masahito Minakawa
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Takashi Shuto
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeremy R McGarvey
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Melissa M Levack
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Francisco Contijoch
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - James J Pilla
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, University of Pennsylvania, 500 S Ridgeway Ave, Glenolden, PA 19036, USA
| | - Joseph H Gorman
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert C Gorman
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
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Yamada K, Isobe S, Suzuki S, Kinoshita K, Yokouchi K, Iwata H, Ohshima S, Hirai M, Sawada K, Murohara T. Diagnostic usefulness of the oedema-infarct ratio to differentiate acute from chronic myocardial damage using magnetic resonance imaging. Eur Radiol 2011; 22:789-95. [DOI: 10.1007/s00330-011-2327-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Revised: 09/30/2011] [Accepted: 10/06/2011] [Indexed: 01/20/2023]
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Witschey WRT, Pilla JJ, Ferrari G, Koomalsingh K, Haris M, Hinmon R, Zsido G, Gorman JH, Gorman RC, Reddy R. Rotating frame spin lattice relaxation in a swine model of chronic, left ventricular myocardial infarction. Magn Reson Med 2011; 64:1453-60. [PMID: 20677236 DOI: 10.1002/mrm.22543] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
T1ρ relaxation times were quantified in a swine model of chronic, left ventricular myocardial infarction. It was found that there were low frequency relaxation mechanisms that suppress endogenous contrast at low spin-lock amplitudes and in T2-weighted images. A moderate amplitude spin-locking pulse could overcome these relaxation mechanisms. Relaxation dispersion data were measured over a range of RF field amplitudes, and a model was formulated to include dipole-dipole relaxation modulated by molecular rotation and an apparent exchange mechanism. These techniques may find some use in the clinic for the observation of chronic, left ventricular cardiac remodeling.
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Affiliation(s)
- Walter R T Witschey
- Department of Radiology, Medical Physics, University Hospital Freiburg, Freiburg im Breisgau, Germany.
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Romagnoli A, Sperandio M, Di Roma M, Giura S, Cicciò C, Della Gatta F, Simonetti G. Anatomical and functional evaluation of the myocardium in patients with acute coronary syndrome (NSTEMI) using MR imaging. Radiol Med 2010; 116:163-77. [PMID: 21311993 DOI: 10.1007/s11547-010-0609-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Accepted: 03/09/2010] [Indexed: 12/16/2022]
Abstract
PURPOSE The aim of our study was to evaluate the role of magnetic resonance (MR) imaging in identifying the location and extent of acute ischaemic injury to predict reversibility and distinguish areas of acute from chronic ischaemia in patients with acute coronary syndrome non- ST-elevation myocardial infarction (NSTEMI). MATERIALS AND METHODS We evaluated 22 patients with NSTEMI acute coronary syndrome confirmed by coronary angiography (CA). We studied ventricular function indices and segmental changes in wall thickness and kinetics by cine-MR imaging sequences. Subsequently, we evaluated myocardial wall oedema with T2-weighted black-blood short-tau inversion recovery turbo spin echo (T2 BB-STIRTSE) sequences and identified areas of myocardial necrosis using T1-weighted turbo field-echo inversion recovery (T1 TFE-IR) sequences after contrast material administration. RESULTS The results obtained with the single sequences were as follows: T2 BB-STIR-TSE: 96.8% sensitivity, 100% specificity, 99.7% negative predictive value, 99.7% positive predictive value; T1 TFE-IR: 45.8% sensitivity, 96.9% specificity, 92.3% negative predictive value, 90.3% positive predictive value; systolic wall thickening: 87.5% sensitivity, 91.8% specificity, 98.7% negative predictive value, 50% positive predictive value, 91.4% accuracy. CONCLUSIONS Our study suggests that the sequences used for evaluating oedema and assessing viability allow for precise localisation and differentiation of areas of acute and chronic ischaemia by quantifying the possible mismatch between ischaemia and necrosis.
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Affiliation(s)
- A Romagnoli
- Terapia Radiante, Università degli studi di Roma "Tor Vergata" (PTV), Viale Oxford 81, 00133, Roma, Italy
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Dall'Armellina E, Karamitsos TD, Neubauer S, Choudhury RP. CMR for characterization of the myocardium in acute coronary syndromes. Nat Rev Cardiol 2010; 7:624-36. [PMID: 20856263 DOI: 10.1038/nrcardio.2010.140] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The utility of cardiac magnetic resonance imaging (CMR) as a diagnostic technique is well established. CMR enables tissue characterization, distinction between myocardial scar tissue and viable tissue, and evaluation of myocardial perfusion and contractile function. To date, CMR has been mostly applied in the assessment of stable disease; however, a role for CMR in the acute setting is also emerging. An accurate appraisal of the myocardium with CMR in the first hours after the onset of chest pain could provide supporting information to standard diagnostic tools, such as electrocardiography and measurement of blood biomarkers, which could help guide the selection of appropriate treatment. The aims of this integrated approach include positive identification of an ischemic syndrome, estimation of downstream areas at risk of damage, evaluation of epicardial artery patency and small vessel integrity, quantification of infarct size, and determination of myocardial function. This Review critically evaluates both established and emerging CMR techniques, and relates the imaging findings to the underlying pathophysiological processes in acute coronary syndromes. A more thorough understanding of CMR techniques will clarify their potential clinical applications and limitations, and assess the practicality of CMR in the setting of acute coronary syndromes, where early intervention is crucial to save myocardium at risk of irreversible injury.
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Affiliation(s)
- Erica Dall'Armellina
- Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
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Okayama S, Uemura S, Watanabe M, Morikawa Y, Onoue K, Soeda T, Iwama H, Somekawa S, Takeda Y, Uramoto H, Kobayashi Y, Saito Y. Novel application of black-blood echo-planar imaging to the assessment of myocardial infarction. Heart Vessels 2010; 25:104-12. [DOI: 10.1007/s00380-009-1172-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Accepted: 04/30/2009] [Indexed: 11/28/2022]
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Cardiac magnetic resonance demonstrates myocardial oedema in remote tissue early after reperfused myocardial infarction. Arch Cardiovasc Dis 2009; 102:633-9. [DOI: 10.1016/j.acvd.2009.05.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Revised: 04/14/2009] [Accepted: 05/18/2009] [Indexed: 01/16/2023]
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Marwick TH, Schwaiger M. The Future of Cardiovascular Imaging in the Diagnosis and Management of Heart Failure, Part 1. Circ Cardiovasc Imaging 2008; 1:58-69. [DOI: 10.1161/circimaging.108.792408] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Thomas H. Marwick
- From the University of Queensland (T.H.M.), Brisbane, Australia, and Technische Universität of Munich (M.S.), Munich, Germany
| | - Markus Schwaiger
- From the University of Queensland (T.H.M.), Brisbane, Australia, and Technische Universität of Munich (M.S.), Munich, Germany
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Eitel I, Behrendt F, Schindler K, Kivelitz D, Gutberlet M, Schuler G, Thiele H. Differential diagnosis of suspected apical ballooning syndrome using contrast-enhanced magnetic resonance imaging. Eur Heart J 2008; 29:2651-9. [DOI: 10.1093/eurheartj/ehn433] [Citation(s) in RCA: 170] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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The salvaged area at risk in reperfused acute myocardial infarction as visualized by cardiovascular magnetic resonance. J Am Coll Cardiol 2008; 51:1581-7. [PMID: 18420102 DOI: 10.1016/j.jacc.2008.01.019] [Citation(s) in RCA: 372] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2007] [Revised: 12/19/2007] [Accepted: 01/06/2008] [Indexed: 12/16/2022]
Abstract
OBJECTIVES We aimed to characterize the tissue changes within the perfusion bed of infarct-related vessels in patients with acutely reperfused myocardial infarction (MI) using cardiovascular magnetic resonance (CMR). BACKGROUND Even in successful early revascularization, intermittent coronary artery occlusion affects the entire perfusion bed, also referred to as the area at risk. The extent of the salvaged area at risk contains prognostic information and may serve as a therapeutic target. Cardiovascular magnetic resonance can visualize the area at risk; yet, clinical data have been lacking. METHODS We studied 92 patients with acute MI and successful reperfusion 3 +/- 3 days after the event and 18 healthy control subjects. Breath-hold T2-weighted and contrast-enhanced ("late enhancement") CMR were used to visualize the reversible and the irreversible myocardial injury, respectively. RESULTS All reperfused infarcts consistently revealed a pattern with both reversibly and irreversibly injured tissue. In contrast to the infarcted area, reversible damage was always transmural, exceeding the infarct in its maximal extent by 16 +/- 11% (absolute difference of the area of maximal infarct expansion 38 +/- 15% vs. 22 +/- 10%; p < 0.0001). None of the controls had significant T2 signal intensity abnormalities. CONCLUSIONS In patients with reperfused MI, CMR visualizes both reversible and irreversible injury. This allows for quantifying the extent of the salvaged area after revascularization as an important parameter for clinical decision-making and research.
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Goldfarb JW, Arnold S, Han J. Recent myocardial infarction: assessment with unenhanced T1-weighted MR imaging. Radiology 2007; 245:245-50. [PMID: 17885192 DOI: 10.1148/radiol.2451061590] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose of the study was to prospectively evaluate a T1-weighted technique for detection of myocardial edema resulting from recent myocardial infarction (MI) or intervention. This study was HIPAA compliant and institutional review board approved. Fifteen men and one woman (mean age, 57.8 years+/-11.5 [standard deviation]) were examined with T1-weighted magnetic resonance (MR) imaging and inversion-recovery cine pulse sequence in two groups, recent MI and chronic MI, and gave informed consent. T1 relaxation times of MI and adjacent myocardium were compared (Student t test and correlation analysis). In patients with recent MI, areas of myocardial edema were well depicted with T1-weighted MR imaging. T1 relaxation times of recent infarcts were longer than those of older MIs (925 msec+/-169 vs 551 msec+/-107, P<.001). From local edema, T1 relaxation time of infarcted myocardium is increased, may remain elevated for 2 months, and enables imaging with T1-weighted techniques.
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Affiliation(s)
- James W Goldfarb
- Department of Research and Education, DeMatteis MRI, St Francis Hospital, 100 Port Washington Blvd, Roslyn, NY 11576, and Program in Biomedical Engineering, SUNY Stony Brook, NY, USA.
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Stork A, Muellerleile K, Bansmann PM, Graessner J, Kaul M, Kemper J, Adam G, Lund GK. Value of T2-weighted, first-pass and delayed enhancement, and cine CMR to differentiate between acute and chronic myocardial infarction. Eur Radiol 2006; 17:610-7. [PMID: 17149626 DOI: 10.1007/s00330-006-0460-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Revised: 07/27/2006] [Accepted: 08/25/2006] [Indexed: 01/22/2023]
Abstract
The aim of this study was to analyze the diagnostic accuracy of edema on T2-weighted (T2w) cardiac magnetic resonance imaging (CMR), presence of microvascular obstruction (MO) on first-pass enhancement (FPE) or on delayed enhancement (DE) CMR, and wall thinning on cine CMR to differentiate between acute (AMI) and chronic myocardial infarction (CMI) in patients with infarction on DE-CMR. Fifty patients were imaged 5 +/- 3 days (baseline) and 8 +/- 3 months (follow-up) after AMI at 1.5 T. Imaging findings were graded as present or absent in a blinded consensus reading. Edema was present at baseline in 48 (96%) patients and absent at follow-up in 49 (98%) patients. At baseline, MO was present in 29 (58%) patients on FPE-CMR and in 24 (48%) patients on DE-CMR (P = ns). At follow-up, persisting hypoenhancement was observed in ten (20%) patients on FPE-CMR, whereas two (4%) patients showed persisting hypoenhancement on DE-CMR (P<0.05). Wall thinning was present in 4 (8%) patients at baseline and in 20 (40%) patients at follow-up. Edema had high sensitivity (96%), specificity (98%), and accuracy (97%) to differentiate between AMI and CMI. Accuracy of all other imaging findings was lower compared to that of edema (P<0.001). In the presence of infarction on DE-CMR, T2w-CMR reliably differentiates between AMI and CMI.
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Affiliation(s)
- Alexander Stork
- Department of Diagnostic and Interventional Radiology, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
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Zoni A, Knoll P, Gherli T. Microvascular obstruction after successful fibrinolytic therapy in acute myocardial infarction. Comparison of reteplase vs reteplase+abciximab: A cardiovascular magnetic resonance study. Heart Int 2006; 2:54. [PMID: 21977252 PMCID: PMC3184656 DOI: 10.4081/hi.2006.54] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND.: About one third of patients with TIMI 3 after reperfusion have evidence of microvascular obstruction (MO) which represents an independent predictor of myocardial wall rupture. This explains all efforts made to prevent MO. Magnetic resonance imaging (MRI) has proved to be particularly useful in detecting MO. The aim of this study was to evaluate with MRI if different fibrinolytic regimens in acute myocardial infarction display different effects on left ventricle (LV) volumes and ejection fraction (EF), as well as on myocardial infarct size (MIsz) and MO. METHODS.: Twenty male patients, mean age 58 years, affected by acute myocardial infarction, ten anterior and ten inferior, were treated with: full dose reteplase in ten, and half dose reteplase plus full dose abciximab (R+Abcx) in the other ten patients. In the fourth day after hospital admission, MRI STIR T2 images were used to quantify MIsz, while 2dflash cineloops were used after the injection of gadolinium, to quantify LV volumes, EF and to detect MO. RESULTS.: LV EF was higher in R+Abcx 51±10 than in reteplase 41±8. MIsz was similar in both treatment groups: however a close relationship was present between MIsz and EF in the reteplase group indicating that the greater the MIsz the lower the EF. In R+Abcx this relationship was no longer present, suggesting a protective effect of the drug on microcirculation. In fact extensive MO was present in 25% of all cases, 80% of which in the reteplase group while only 20% in R+Abcx. CONCLUSION.: R+Abcx prevents MO: compared to traditional fibrinolytic therapy it allows better LV function and most likely improved long term survival.
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Affiliation(s)
- Antonello Zoni
- Heart Department, University Hospital of Parma, Parma - Italy
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Stork A, Lund GK, Muellerleile K, Bansmann PM, Nolte-Ernsting C, Kemper J, Begemann PGC, Adam G. Characterization of the peri-infarction zone using T2-weighted MRI and delayed-enhancement MRI in patients with acute myocardial infarction. Eur Radiol 2006; 16:2350-7. [PMID: 16625349 DOI: 10.1007/s00330-006-0232-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2005] [Revised: 02/16/2006] [Accepted: 03/02/2006] [Indexed: 11/27/2022]
Abstract
To characterize the peri-infarction zone using T2-weighted (T2w) magnetic resonance imaging (MRI) and infarct size on delayed enhancement (DE) MRI in patients with acute myocardial infarction (AMI). In 65 patients, short-axis T2w and DE MRI images were acquired 5 +/- 3 d after AMI. The MRI was analyzed using a threshold method defining infarct size on DE MRI and edema on T2w MRI as areas with signal intensity larger than +2 SD above remote normal myocardium. The peri-infarction zone was calculated as the difference between the size of edema and the infarct size. The size of edema on T2w MRI (31.3 +/- 13.4% of LV area) was larger than the infarct size on DE MRI (20.3 +/- 10.4% of LV area, p< 0.0001). The size of the peri-infarction zone was 11.0 +/- 10.0% of the LV area. Good correlation was found between infarct size on DE MRI and peak creatine kinase (CK) isoenzyme MB (r = 0.65, p< 0.0001), but there was no correlation between the size of the peri-infarction zone and CK MB (r = 0.05, p = 0.67). The peri-infarction zone was larger in patients with an infarct size <28% of the LV area (12.6 +/- 10.0% LV area) compared with patients with an infarct size > or =28% of the LV area (6.7 +/- 9.0% of the LV area, p< 0.05). The peri-infarction zone does not correlate with enzymatic parameters of infarct size and is substantially larger in small infarcts, indicating viable myocardium.
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Affiliation(s)
- Alexander Stork
- Department of Diagnostic and Interventional Radiology, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
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Aletras AH, Tilak GS, Natanzon A, Hsu LY, Gonzalez FM, Hoyt RF, Arai AE. Retrospective determination of the area at risk for reperfused acute myocardial infarction with T2-weighted cardiac magnetic resonance imaging: histopathological and displacement encoding with stimulated echoes (DENSE) functional validations. Circulation 2006; 113:1865-70. [PMID: 16606793 DOI: 10.1161/circulationaha.105.576025] [Citation(s) in RCA: 451] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The aim of this study was to determine whether edema imaging by T2-weighted cardiac magnetic resonance (CMR) imaging could retrospectively delineate the area at risk in reperfused myocardial infarction. We hypothesized that the size of the area at risk during a transient occlusion would be similar to the T2-weighted hyperintense region observed 2 days later, that the T2-weighted hyperintense myocardium would show partial functional recovery after 2 months, and that the T2 abnormality would resolve over 2 months. METHODS AND RESULTS Seventeen dogs underwent a 90-minute coronary artery occlusion, followed by reperfusion. The area at risk, as measured with microspheres (9 animals), was comparable to the size of the hyperintense zone on T2-weighted images 2 days later (43.4+/-3.3% versus 43.0+/-3.4% of the left ventricle; P=NS), and the 2 measures correlated (R=0.84). The infarcted zone was significantly smaller (23.1+/-3.7; both P<0.001). To test whether the hyperintense myocardium would exhibit partial functional recovery over time, 8 animals were imaged on day 2 and 2 months later. Systolic strain was mapped with displacement encoding with stimulated echoes. Edema, as detected by a hyperintense zone on T2-weighted images, resolved, and regional radial systolic strain partially improved from 4.9+/-0.7 to 13.1+/-1.5 (P=0.001) over 2 months. CONCLUSIONS These findings are consistent with the premise that the T2 abnormality depicts the area at risk, a zone of reversibly and irreversibly injured myocardium associated with reperfused subendocardial infarctions. The persistence of postischemic edema allows T2-weighted CMR to delineate the area at risk 2 days after reperfused myocardial infarction.
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Affiliation(s)
- Anthony H Aletras
- National Heart, Lung and Blood Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD 20892-1061, USA
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Zoni A, Knoll P, Gherli T. Microvascular Obstruction after Successful Fibrinolytic Therapy in Acute Myocardial Infarction. Comparison of Reteplase vs Reteplase+Abciximab: A Cardiovascular Magnetic Resonance Study. Heart Int 2006. [DOI: 10.1177/182618680600200109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Antonello Zoni
- Heart Department, University Hospital of Parma, Parma - Italy
| | - Peter Knoll
- Division of Cardiology, General Hospital of Bolzano - Italy
| | - Tiziano Gherli
- Heart Department, University Hospital of Parma, Parma - Italy
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Schulz-Menger J, Gross M, Messroghli D, Uhlich F, Dietz R, Friedrich MG. Cardiovascular magnetic resonance of acute myocardial infarction at a very early stage. J Am Coll Cardiol 2003; 42:513-8. [PMID: 12906982 DOI: 10.1016/s0735-1097(03)00717-4] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Very early changes in myocardial tissue composition during acute myocardial infarction (AMI) are difficult to assess in vivo. Cardiovascular magnetic resonance (CMR) imaging provides techniques for visualizing tissue pathology. BACKGROUND The diagnostic role of CMR in very acute stages of myocardial infarction is uncertain. We investigated signal intensity changes beginning within 60 min after acute coronary occlusion in patients undergoing therapeutic septal artery embolization. METHODS We investigated eight patients with hypertrophic obstructive cardiomyopathy undergoing interventional septal artery embolization by applying microparticles to reduce left ventricular outflow tract obstruction. In a clinical 1.5-tesla (T) CMR system, we visualized infarct-related myocardial signal by T(1)-weighted sequences before and 20 min after administration of contrast media (delayed enhancement) and edema-related signal by T(2)-weighted spin-echo sequences before and 58 +/- 14 min after the intervention as well as on days 1, 3, 7, 14, 28, 90, and 180 during follow-up. RESULTS Infarct-related changes as defined by contrast enhancement were observed as early as 1 h after the intervention and during six months of follow-up. In contrast, infarct-related myocardial edema, as visualized by high signal intensity in T(2)-weighted spin-echo sequences, was not consistently detectable 1 h after acute arterial occlusion; this was possible in all subsequent studies until day 28. CONCLUSIONS Contrast-enhanced magnetic resonance imaging detected infarct-related signal changes as early as 1 h after AMI in humans, whereas the sensitivity of edema-related signal changes was not sufficient during this very early stage.
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Affiliation(s)
- Jeanette Schulz-Menger
- Franz Volhard Clinic at the Max Delbrück Center, Helios-Klinikum, Berlin-Buch, Medical Faculty of the Charité, Department Cardiology, Humboldt University of Berlin, Berlin, Germany.
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Cherryman GR, Pirovano G, Kirchin MA. Gadobenate dimeglumine in MRI of acute myocardial infarction: results of a phase III study comparing dynamic and delayed contrast enhanced magnetic resonance imaging with EKG, (201)Tl SPECT, and echocardiography. Invest Radiol 2002; 37:135-45. [PMID: 11882793 DOI: 10.1097/00004424-200203000-00006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the safety and utility of gadobenate dimeglumine as a magnetic resonance (MR) contrast agent in patients with acute myocardial infarction (MI). METHODS One hundred three patients with acute MI received intravenous bolus gadobenate dimeglumine (0.05 mmol/kg) during MR examination. Dynamic and delayed T1-weighted spin-echo postcontrast images were compared with precontrast images, EKG, resting (201)Tl SPECT and echocardiography. RESULTS Gadobenate dimeglumine was well tolerated. Dynamic imaging with gadobenate dimeglumine was more sensitive (72% vs 56%) than delayed spin echo imaging (P < 0.001). No difference in specificity was seen (98% vs 99%). (201)Tl SPECT was a sensitive (96%) test, but was not specific (63%). Echocardiography was not sensitive (32%), but was specific (92%). CONCLUSION The intravenous use of gadobenate dimeglumine, at a bolus dose of 0.05 mmol/kg, is safe in patients with an acute MI. Dynamic contrast enhanced MR imaging has moderate sensitivity and high specificity for demonstrating infarct.
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Affiliation(s)
- Graham R Cherryman
- University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
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