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Corban MT, Khorramirouz R, Yang SW, Lewis BR, Bois J, Foley T, Lerman LO, Oh JK, Lerman A. Non-infarct related artery microvascular obstruction is associated with worse persistent diastolic dysfunction in patients with revascularized ST elevation myocardial infarction. Int J Cardiol 2020; 300:27-33. [DOI: 10.1016/j.ijcard.2019.09.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/09/2019] [Accepted: 09/18/2019] [Indexed: 12/18/2022]
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2
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Lou B, Cui Y, Gao H, Chen M. Meta-analysis of the effects of ischemic postconditioning on structural pathology in ST-segment elevation acute myocardial infarction. Oncotarget 2018; 9:8089-8099. [PMID: 29487717 PMCID: PMC5814284 DOI: 10.18632/oncotarget.23450] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 10/05/2017] [Indexed: 01/08/2023] Open
Abstract
In this meta-analysis, we assessed cardiac magnetic resonance imaging data to determine the effects of local and remote ischemic postconditioning (LPoC and RPoC, respectively) on structural pathology in ST-segmentel elevation acute myocardial infarction (STEMI). We searched the Pubmed, Embase and Cochrane Library databases up to May 2017 and included 12 randomized controlled trials (10 LPoC and 2 RPoC)containing 1069 study subjects with thrombolysis in myocardial infarction flow grade 0~1. Weighed mean difference (WMD), standardized mean difference (SMD), and odds ratio (OR) were used for the pooled analysis. Random-effect model was used for the potential clinical inconsistency. LPoC and RPoC increased the myocardial salvage index (n = 5; weighted mean difference (WMD) = 5.52; P = 0.005; I2 = 76.0%), and decreased myocardial edema (n = 7; WMD = -3.35; P = 0.0009; I2 = 18.0%). However, LPoC and RPoC did not reduce the final infarct size (n = 10; WMD = -1.01; P > 0.05; I2 = 68.0%), left ventricular volume (n = 10; standardized mean difference = 0.23; P > 0.05; I2 = 93.0%), the incidence of microvascular obstruction (n = 6; OR = 0.99; P > 0.05; I2 = 0.0%) or the extent of microvascular obstruction (n = 3; WMD = -0.09; P > 0.05; I2 = 6.0%). This meta-analysis shows that LPoC and/or RPoC improves myocardial salvage and decreases myocardial edema in STEMI patients without affecting final infarct size, left ventricular volume or microvascular obstruction.
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Affiliation(s)
- Baohui Lou
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Yadong Cui
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Haiyang Gao
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Min Chen
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing, China
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3
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Aortic stiffness in type-1 diabetes mellitus; beware of hypertension. Int J Cardiovasc Imaging 2012; 28:551-4. [PMID: 21442264 PMCID: PMC3326363 DOI: 10.1007/s10554-011-9850-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Accepted: 03/10/2011] [Indexed: 12/02/2022]
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4
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van der Wall EE, de Graaf FR, van Velzen JE, Jukema JW, Bax JJ, Schuijf JD. 320-row CT: does beat-to-beat motion of the coronary arteries affect image quality? Int J Cardiovasc Imaging 2011; 28:147-51. [PMID: 21279691 PMCID: PMC3275735 DOI: 10.1007/s10554-010-9794-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Accepted: 12/30/2010] [Indexed: 11/24/2022]
Affiliation(s)
- E. E. van der Wall
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, The Netherlands
| | - F. R. de Graaf
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, The Netherlands
| | - J. E. van Velzen
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, The Netherlands
| | - J. W. Jukema
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, The Netherlands
| | - J. J. Bax
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, The Netherlands
| | - J. D. Schuijf
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, The Netherlands
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5
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Magnetic resonance imaging of myocardial injury and ventricular torsion after marathon running. Clin Sci (Lond) 2011; 120:143-52. [PMID: 20815809 DOI: 10.1042/cs20100206] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Recent reports provide indirect evidence of myocardial injury and ventricular dysfunction after prolonged exercise. However, existing data is conflicting and lacks direct verification of functional myocardial alterations by CMR [cardiac MR (magnetic resonance)]. The present study sought to examine structural myocardial damage and modification of LV (left ventricular) wall motion by CMR imaging directly after a marathon. Analysis of cTnT (cardiac troponin T) and NT-proBNP (N-terminal pro-brain natriuretic peptide) serum levels, echocardiography [pulsed-wave and TD (tissue Doppler)] and CMR were performed before and after amateur marathon races in 28 healthy males aged 41 ± 5 years. CMR included LGE (late gadolinium enhancement) and myocardial tagging to assess myocardial injury and ventricular motion patterns. Echocardiography indicated alterations of diastolic filling [decrease in E/A (early transmitral diastolic filling velocity/late transmitral diastolic filling velocity) ratio and E' (tissue Doppler early transmitral diastolic filling velocity)] postmarathon. All participants had a significant increase in NT-proBNP and/or cTnT levels. However, we found no evidence of LV LGE. MR tagging demonstrated unaltered radial shortening, circumferential and longitudinal strain. Myocardial rotation analysis, however, revealed an increase of maximal torsion by 18.3% (13.1 ± 3.8 to 15.5 ± 3.6 °; P=0.002) and maximal torsion velocity by 35% (6.8 ± 1.6 to 9.2 ± 2.5 °·s-1; P<0.001). Apical rotation velocity during diastolic filling was increased by 1.23 ± 0.33 °·s-1 after marathon (P<0.001) in a multivariate analysis adjusted for heart rate, whereas peak untwist rate showed no relevant changes. Although marathon running leads to a transient increase of cardiac biomarkers, no detectable myocardial necrosis was observed as evidenced by LGE MRI (MR imaging). Endurance exercise induces an augmented systolic wringing motion of the myocardium and increased diastolic filling velocities. The stress of marathon running seems to be better described as a burden of myocardial overstimulation rather than cardiac injury.
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van der Wall EE, de Graaf FR, van Velzen JE, Jukema JW, Schuijf JD, Bax JJ. Functional analysis by 64-slice CT scanning: prediction of left ventricular dysfunction together with reduction in radiation exposure? Int J Cardiovasc Imaging 2010; 27:1089-93. [PMID: 21170591 PMCID: PMC3182322 DOI: 10.1007/s10554-010-9771-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Accepted: 12/08/2010] [Indexed: 11/24/2022]
Affiliation(s)
- E E van der Wall
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, The Netherlands.
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van der Wall EE, van Velzen JE, de Graaf FR, Jukema JW, Schuijf JD, Bax JJ. 320-row CT scanning: reduction in tube current parallels reduction in radiation exposure? Int J Cardiovasc Imaging 2010; 28:193-7. [PMID: 21136168 PMCID: PMC3275722 DOI: 10.1007/s10554-010-9762-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 11/26/2010] [Indexed: 11/13/2022]
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8
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van der Wall EE, Zeppenfeld K, Bax JJ, Siebelink HM, Schalij MJ. CMR-determined scar volume: predictive for ventricular tachycardias? Int J Cardiovasc Imaging 2010; 27:989-93. [PMID: 21061171 PMCID: PMC3182320 DOI: 10.1007/s10554-010-9744-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 10/27/2010] [Indexed: 11/30/2022]
Abstract
The interesting data reported by Bernhardt et al. strengthen the diagnostic benefit of CMR in patients with ischemic cardiomyopathy. Consequently, the presence, location and size of the CMR-determined scar tissue may be used for better risk stratification in patients with ischemic cardiomyopathy eligible for ICD therapy.
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Affiliation(s)
- E. E. van der Wall
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, Netherlands
| | - K. Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, Netherlands
| | - J. J. Bax
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, Netherlands
| | - H. M. Siebelink
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, Netherlands
| | - M. J. Schalij
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, Netherlands
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van der Wall EE, Reiber JHC. Assessment of left ventricular function: visual or quantitative? Int J Cardiovasc Imaging 2010; 27:573-7. [PMID: 20981573 PMCID: PMC3101355 DOI: 10.1007/s10554-010-9735-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Accepted: 10/13/2010] [Indexed: 01/08/2023]
Affiliation(s)
- E. E. van der Wall
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, Netherlands
| | - J. H. C. Reiber
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, Netherlands
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10
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Assessment of left ventricular volumes; reliable by gated SPECT? Int J Cardiovasc Imaging 2010; 27:635-8. [PMID: 20924791 PMCID: PMC3101353 DOI: 10.1007/s10554-010-9717-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Accepted: 09/23/2010] [Indexed: 11/24/2022]
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11
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100 kV versus 120 kV: effective reduction in radiation dose? Int J Cardiovasc Imaging 2010; 27:587-91. [PMID: 20809283 PMCID: PMC3101358 DOI: 10.1007/s10554-010-9693-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Accepted: 08/24/2010] [Indexed: 11/13/2022]
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12
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van der Wall EE, Delgado V, Holman ER, Bax JJ. Speckle tracking: distinction of physiologic from pathologic LVH? Int J Cardiovasc Imaging 2010; 27:101-4. [PMID: 20734233 PMCID: PMC3035794 DOI: 10.1007/s10554-010-9689-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 08/13/2010] [Indexed: 11/03/2022]
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13
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van der Wall EE, Holman ER, Scholte AJ, Bax JJ. Echocardiography in Takotsubo cardiomyopathy; a useful approach? Int J Cardiovasc Imaging 2010; 26:537-40. [PMID: 20390358 PMCID: PMC2868168 DOI: 10.1007/s10554-010-9629-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Accepted: 04/02/2010] [Indexed: 11/24/2022]
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14
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van der Wall EE, Scholte AJ, Bax JJ. Gated myocardial SPECT imaging; true additional value in AMI? Int J Cardiovasc Imaging 2010; 26:893-6. [PMID: 20532632 PMCID: PMC2991157 DOI: 10.1007/s10554-010-9650-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 05/27/2010] [Indexed: 12/01/2022]
Affiliation(s)
- E. E. van der Wall
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, Netherlands
| | - A. J. Scholte
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, Netherlands
| | - J. J. Bax
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, Netherlands
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15
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Use of the anterior-posterior chest diameter in CT: reduction in radiation dose? Int J Cardiovasc Imaging 2010; 26:941-5. [PMID: 20526742 PMCID: PMC2991165 DOI: 10.1007/s10554-010-9647-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Accepted: 05/21/2010] [Indexed: 01/07/2023]
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16
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Cardiac magnetic resonance imaging analysis in STEMI: quantitative or still visual? Int J Cardiovasc Imaging 2010; 27:965-8. [PMID: 20454931 PMCID: PMC3182319 DOI: 10.1007/s10554-010-9638-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Accepted: 04/24/2010] [Indexed: 12/04/2022]
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17
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van der Wall EE, Scholte AJ, Holman ER, Bax JJ. Stress imaging in patients with diabetes; routine practice? Int J Cardiovasc Imaging 2010; 27:939-42. [PMID: 20454930 PMCID: PMC3182325 DOI: 10.1007/s10554-010-9639-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Accepted: 04/26/2010] [Indexed: 11/29/2022]
Affiliation(s)
- E. E. van der Wall
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, Netherlands
| | - A. J. Scholte
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, Netherlands
| | - E. R. Holman
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, Netherlands
| | - J. J. Bax
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, Netherlands
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18
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Affiliation(s)
| | - M. J. Schalij
- Leiden University Medical Center, Leiden, The Netherlands
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van der Wall EE, Siebelink HM, Scholte AJ, Bax JJ. Positron emission tomography; viable tool in patients pre-CABG? Int J Cardiovasc Imaging 2010; 26:661-4. [PMID: 20358291 PMCID: PMC2898113 DOI: 10.1007/s10554-010-9612-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Accepted: 03/05/2010] [Indexed: 11/30/2022]
Affiliation(s)
- E. E. van der Wall
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, Netherlands
| | - H. M. Siebelink
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, Netherlands
| | - A. J. Scholte
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, Netherlands
| | - J. J. Bax
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, Netherlands
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van der Wall EE, Siebelink HM, Bax JJ. Left ventricular mass assessment by CMR; how to define the optimal index. Int J Cardiovasc Imaging 2010; 26:469-72. [PMID: 20213471 PMCID: PMC2852595 DOI: 10.1007/s10554-010-9602-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Accepted: 02/08/2010] [Indexed: 11/26/2022]
Affiliation(s)
- E. E. van der Wall
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, Netherlands
| | - H. M. Siebelink
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, Netherlands
| | - J. J. Bax
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, Netherlands
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21
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Affiliation(s)
| | - J. J. Bax
- Leiden University Medical Center, Leiden, The Netherlands
| | - J. W. Jukema
- Leiden University Medical Center, Leiden, The Netherlands
| | - M. J. Schalij
- Leiden University Medical Center, Leiden, The Netherlands
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van der Wall EE. Tissue characterization in Takotsubo cardiomyopathy; a valuable approach? Int J Cardiovasc Imaging 2010; 26:233-6. [PMID: 20175295 PMCID: PMC2817074 DOI: 10.1007/s10554-009-9534-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Accepted: 10/29/2009] [Indexed: 11/26/2022]
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23
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Pätilä T, Ikonen T, Kankuri E, Ahonen A, Krogerus L, Lauerma K, Harjula A. Spontaneous recovery of myocardial function after ligation of Ameroid-stenosed coronary artery. SCAND CARDIOVASC J 2009; 43:408-16. [DOI: 10.1080/14017430902951756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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24
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Cardiovascular dynamics in ischemic cardiomyopathy during exercise. Int J Cardiovasc Imaging 2009; 26:161-4. [PMID: 19937127 PMCID: PMC2817072 DOI: 10.1007/s10554-009-9533-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Accepted: 10/29/2009] [Indexed: 11/30/2022]
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Wagner GS, Hakacova N. Electrocardiographic measures of myocardial function and necrosis. JACC Cardiovasc Imaging 2009; 2:1195-7. [PMID: 19833309 DOI: 10.1016/j.jcmg.2009.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Accepted: 08/18/2009] [Indexed: 11/29/2022]
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26
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Hedström E, Aström-Olsson K, Ohlin H, Frogner F, Carlsson M, Billgren T, Jovinge S, Cain P, Wagner GS, Arheden H. Peak CKMB and cTnT accurately estimates myocardial infarct size after reperfusion. SCAND CARDIOVASC J 2009; 41:44-50. [PMID: 17365977 DOI: 10.1080/14017430601071849] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To find the time-to-peak for creatine kinase MB(mass) (CKMB) and cardiac troponin T (cTnT) after acute reperfusion, to compare peak and cumulative values to estimate infarct size (IS), and to evaluate clinical routine sampling for assessment of IS. DESIGN Acute primary percutaneous coronary intervention (PCI) was performed in 38 patients with first-time myocardial infarction. In 21 patients, CKMB and cTnT were acquired before PCI and at 1.5, 3, 6, 12, 18, 24, and 48 hours thereafter. In 17 patients, clinical routine samples were acquired at arrival, and at 10 and 20 h. IS was assessed by delayed contrast-enhanced MRI (DE-MRI). RESULTS Time-to-peak was 7.6+/-3.6 h for CKMB and 8.1+/-3.4 h for cTnT. Peak values correlated strongly to cumulative values (r(s)=0.97-0.98) as well as to DE-MRI (r(s)=0.8-0.82). Clinical routine sampling showed lower rs values (0.47-0.60). CONCLUSIONS Peak values are likely captured if CKMB and cTnT are acquired at 3, 6, and 12 h after acute PCI. These peak values can be used to estimate myocardial infarct size after acute PCI.
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Affiliation(s)
- Erik Hedström
- Department of Clinical Physiology, Lund University, Lund, Sweden
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27
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van der Wall EE, Bax JJ, Jukema JW, Schalij MJ. Cardiac magnetic resonance imaging in primary PCI: additional value? Int J Cardiovasc Imaging 2009; 25:643-5. [PMID: 19468863 PMCID: PMC2712062 DOI: 10.1007/s10554-009-9466-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Accepted: 04/16/2009] [Indexed: 11/29/2022]
Affiliation(s)
- E E van der Wall
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
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28
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Abstract
Contemporary methods for evaluation and treatment of arrhythmia are increasingly dependent upon characterization of the underlying myocardial substrate. Cardiovascular magnetic resonance offers unsurpassed soft tissue resolution capable of visualizing detailed cardiac anatomic features and intra-myocardial barriers to conduction. Non-invasive visualization of such anatomic detail has the potential to improve methods to diagnose, risk stratify, and treat patients with arrhythmia. This review describes a brief overview of the current knowledge on the applications of cardiac magnetic resonance for evaluation and treatment of patients with arrhythmia.
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Affiliation(s)
- Saman Nazarian
- Division of Cardiology/Cardiac Arrhythmia, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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29
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Giannitsis E, Steen H, Kurz K, Ivandic B, Simon AC, Futterer S, Schild C, Isfort P, Jaffe AS, Katus HA. Cardiac Magnetic Resonance Imaging Study for Quantification of Infarct Size Comparing Directly Serial Versus Single Time-Point Measurements of Cardiac Troponin T. J Am Coll Cardiol 2008; 51:307-14. [DOI: 10.1016/j.jacc.2007.09.041] [Citation(s) in RCA: 139] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2007] [Revised: 08/10/2007] [Accepted: 09/07/2007] [Indexed: 11/26/2022]
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30
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Walsh TF, Hundley WG. Assessment of Ventricular Function with Cardiovascular Magnetic Resonance. Magn Reson Imaging Clin N Am 2007; 15:487-504, v. [DOI: 10.1016/j.mric.2007.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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31
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Abstract
The high spatial and temporal resolution of cardiovascular magnetic resonance (CMR) images makes it well-suited for use in the assessment of right ventricular and left ventricular function in patients who have cardiovascular disorders. This article reviews CMR methods used to assess regional and global ventricular function.
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Affiliation(s)
- Thomas F Walsh
- Department of Internal Medicine, Wake Forest University School of Medicine, Bowman Gray Campus, Medical Center Boulevard, Winston-Salem, NC 27157-1045, USA
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32
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Warda HM, Bax JJ, Bosch JG, Atsma DE, Jukema JW, van der Wall EE, van der Laarse A, Schalij MJ, Oemrawsingh PV. Effect of intracoronary aqueous oxygen on left ventricular remodeling after anterior wall ST-elevation acute myocardial infarction. Am J Cardiol 2005; 96:22-4. [PMID: 15979426 DOI: 10.1016/j.amjcard.2005.02.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2004] [Revised: 02/22/2005] [Accepted: 02/22/2005] [Indexed: 11/17/2022]
Abstract
The present report describes outcomes of randomized selective intracoronary aqueous oxygen versus standard care in patients who had acute anterior wall myocardial infarction within 6 hours of onset (n = 50). Left ventricular (LV) dimensions and function were assessed by contrast echocardiography at baseline and 1 month. It is demonstrated that aqueous oxygen prevents LV remodeling and preserves LV ejection fraction.
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Affiliation(s)
- Hazem M Warda
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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Blyth KG, Groenning BA, Martin TN, Foster JE, Mark PB, Dargie HJ, Peacock AJ. Contrast enhanced-cardiovascular magnetic resonance imaging in patients with pulmonary hypertension. Eur Heart J 2005; 26:1993-9. [PMID: 15899927 DOI: 10.1093/eurheartj/ehi328] [Citation(s) in RCA: 172] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
AIMS To determine the presence and extent of delayed contrast enhancement (DCE) in patients with pulmonary hypertension (PHT) using contrast enhanced-cardiovascular magnetic resonance imaging (ce-CMR). METHODS AND RESULTS Twenty-five patients with PHT underwent ce-CMR and right heart catheterization. Right ventricular (RV) and left ventricular (LV) volumes, ejection fraction, mass, and DCE mass were determined with ce-CMR. Mean pulmonary artery pressure (mean PAP) averaged 43 (12) mmHg and cardiac output 4.3 (1.2) L/min. DCE was demonstrated in 23 out of 25 patients. DCE was confined to the RV insertion points (RVIPs) in seven patients and extended into the interventricular septum (IVS) in the remaining 16 patients. In these 16 patients, septal contrast enhancement was associated with IVS bowing. The extent of contrast enhancement correlated positively with RV end-diastolic volume/body surface area, RV mass, mean PAP, and pulmonary vascular resistance and correlated inversely with RV ejection fraction. CONCLUSION DCE was present within the RVIPs and IVS of most patients with PHT studied. Extent of DCE correlated with RV function and pulmonary haemodynamics. DCE was associated with IVS bowing and may provide a novel marker for occult septal abnormalities directly relating to the haemodynamic stress experienced by these patients.
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Affiliation(s)
- Kevin G Blyth
- Scottish Pulmonary Vascular Unit, Level 8, Western Infirmary, Glasgow G11 6NT, UK
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Hombach V, Grebe O, Merkle N, Waldenmaier S, Höher M, Kochs M, Wöhrle J, Kestler HA. Sequelae of acute myocardial infarction regarding cardiac structure and function and their prognostic significance as assessed by magnetic resonance imaging. Eur Heart J 2005; 26:549-57. [PMID: 15713695 DOI: 10.1093/eurheartj/ehi147] [Citation(s) in RCA: 400] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
AIMS Because of its high spatial resolution and tissue contrast, magnetic resonance imaging (MRI) was used to assess cardiac structure and function in a large population of patients with acute myocardial infarction (AMI). METHODS AND RESULTS One hundred and ten patients were studied by MRI 6.1 +/- 2.2 days after AMI. Infarct size (IS), persistent microvascular obstruction (PMO), left and right ventricular (LV/RV) volumes, and functions were measured. The same MRI measurements were repeated in 89 patients after a mean follow-up period of 225 +/- 92 days. IS was 11.9 +/- 7.3% of total LV muscle mass. PMO was detected in 51/110 (46.4%) patients and comprised 15.6 +/- 8.5% of IS and 2.8 +/- 2.3% of LV muscle mass. Papillary muscle infarct was seen in 26%, RV infarction in 16%, pericarditis in 40%, and pericardial effusion in 66% of the patients. During follow-up, there were 16 major adverse cardiac events (MACE) including seven deaths. IS, PMO, and amount of transmural infarction were predictive for LV adverse remodelling defined as > 20% increase in LV end-diastolic volume. Multivariable analysis revealed LV end-diastolic volume, LV ejection fraction, and PMO as significant predictors for the occurrence of MACE. CONCLUSION MRI is a highly sensitive and reliable tool to detect morphologic and functional sequelae of AMI providing baseline MRI parameters with relevant predictive power for LV adverse remodelling and occurrence of MACE.
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Affiliation(s)
- Vinzenz Hombach
- Department of Internal Medicine II-Cardiology, University of Ulm, Robert-Koch-Strasse 8, D-89081 Ulm, Germany.
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Gallegos RP, Swingen C, Xu XJ, Wang X, Bianco R, Jerosch-Herold M, Bolman RM. Infarct extent by MRI corelates with peak serum troponin level in the canine model1. J Surg Res 2004; 120:266-71. [PMID: 15234222 DOI: 10.1016/j.jss.2004.02.025] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2003] [Indexed: 11/25/2022]
Abstract
BACKGROUND Serum Troponin I is used routinely as an adjunct to EKG for the diagnosis of myocardial infarction (MI); however, a correlation between marker level and infarct size has yet to be documented in vivo. We report findings from a chronic coronary artery ligation model in the canine (n = 12) in which peak Troponin I is related to infarct size as determined by high-resolution cardiac magnetic resonance imaging. METHODS All animals underwent a left anterior thoracotomy to allow for ligation of the left anterior descending artery. Evidence of myocardial infarction, including EKG changes, elevated Troponin I, along with visual reduction in perfusion and wall motion, was noted in all animals. Thirty days after surgical intervention, cine MRI and contrast-enhanced MRI were performed. Dedicated analysis software was used to quantify global infarction size, LV function and to map regions of MI to a 3D model of the left ventricle. RESULTS A linear relationship between infarct extent and peak Troponin I level exists (r = 0.98, P < 0.0001). In addition, we observed a negative trend between infarct extent, peak Troponin I, and ejection fraction. CONCLUSION The findings of this study indicate that Troponin I and cardiac magnetic resonance imaging provide a more accurate estimation of infarct size than was previously reported using markers with less sensitivity and imaging modalities of lower spatial resolution and viability imaging capability.
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Affiliation(s)
- Robert P Gallegos
- Division of Cardiovascular and Thoracic Surgery and Experimental Surgical Services, Department of Surgery, MMC 20, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455 USA.
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Lund GK, Stork A, Saeed M, Bansmann MP, Gerken JH, Müller V, Mester J, Higgins CB, Adam G, Meinertz T. Acute Myocardial Infarction: Evaluation with First-Pass Enhancement and Delayed Enhancement MR Imaging Compared with201Tl SPECT Imaging. Radiology 2004; 232:49-57. [PMID: 15166320 DOI: 10.1148/radiol.2321031127] [Citation(s) in RCA: 148] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate acute myocardial infarction by using first-pass enhancement (FPE) and delayed enhancement (DE) magnetic resonance (MR) imaging compared with thallium 201 ((201)Tl) single photon emission computed tomography (SPECT). MATERIALS AND METHODS Contrast material-enhanced FPE MR, inversion-recovery DE MR, and rest-redistribution (201)Tl SPECT images were obtained in 60 consecutive patients (53 men, seven women; mean age [+/- SD], 56 years +/- 13; range, 30-78 years) at 6 days +/- 3 after reperfused first myocardial infarction. Presence of microvascular obstruction was determined on FPE MR images. Infarct size was defined on DE MR images as percentage of left ventricular (LV) area and compared with uptake defect on redistribution (201)Tl SPECT images. Differences in continuous data were analyzed with Student t test. Linear regression and Bland-Altman analysis were used to compare measurements of infarct size. RESULTS Mean infarct size was not significantly different between DE MR imaging (20.7% +/- 11.5% of LV area) and (201)Tl SPECT (19.4% +/- 14.3% of LV area; P =.26); good correlation (r = 0.73; P <.001) and agreement were found, with a mean difference of +1.3% +/- 9.8% of LV area. (201)Tl SPECT failed to depict infarct in six (20%) of 30 patients with inferior myocardial infarction (mean size, 6.4% +/- 5.7% of LV area on DE MR images), whereas DE MR images showed the infarct in all patients (P <.01). FPE MR images depicted microvascular obstruction in 23 (38%) of 60 patients; these patients had larger infarctions at DE MR imaging than did patients without microvascular obstruction (30.4% +/- 9.0% vs 15.1% +/- 8.4% of LV area, P <.001). (201)Tl SPECT showed larger infarcts in patients with microvascular obstruction (26.7% +/- 16.2% vs 15.0% +/- 11.2% of LV area, P <.01). CONCLUSION Good correlation and agreement with (201)Tl SPECT indicate DE MR imaging may be used to estimate infarct size 6 days after reperfused acute myocardial infarction. DE MR imaging is more sensitive for detection of inferior infarction than is (201)Tl SPECT. Patients with microvascular obstruction on FPE MR images have larger infarcts.
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Affiliation(s)
- Gunnar K Lund
- Department of Cardiology, University Hospital Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
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Weiss CR, Aletras AH, London JF, Taylor JL, Epstein FH, Wassmuth R, Balaban RS, Arai AE. Stunned, infarcted, and normal myocardium in dogs: simultaneous differentiation by using gadolinium-enhanced cine MR imaging with magnetization transfer contrast. Radiology 2003; 226:723-30. [PMID: 12616019 DOI: 10.1148/radiol.2263012196] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To simultaneously differentiate stunned, infarcted, and normal myocardial regions by using gadolinium-enhanced cine magnetic resonance (MR) imaging with magnetization transfer contrast. MATERIALS AND METHODS Twelve dogs were imaged on days 1 and 8 after transient 90-minute coronary artery occlusion. A magnetization transfer contrast with echo-train readout (MTET) MR sequence was performed before and 30 minutes after gadolinium contrast enhancement. Ex vivo analysis consisted of MR imaging, microsphere blood flow analysis, and triphenyltetrazolium chloride (TTC) staining. A paired two-tailed t test was used to compare wall thickening from day 1 to day 8. Linear regression and Bland-Altman analyses were used to compare infarct size depicted with MTET imaging with that seen on TTC-stained tissue. RESULTS Severe wall motion abnormalities were detected in all dogs. At TTC analysis, seven dogs had evidence of myocardial infarction and five had evidence of stunned myocardium. The mean percentages of left ventricular wall thickening in infarcted, stunned, and remote myocardial regions were 2% +/- 4 (SD), 4% +/- 8, and 33% +/- 5, respectively. Wall thickening did not improve in the infarcted zones, but it improved to nearly normal levels in the stunned region 1 week after induced occlusion (mean, 40% +/- 8; P <.02). MTET images clearly depicted infarcted myocardium as brighter than both the normal and stunned myocardial regions but darker than the blood pool. In vivo MTET infarct volume correlated with ex vivo TTC analysis data (y = 1.01x + 0.00, R = 0.98, standard error of the estimate = 0.019). CONCLUSION One day after myocardial ischemia, MTET during one MR imaging examination enabled simultaneous differentiation of infarcted, stunned, and normal myocardial regions on the basis of gadolinium enhancement and regional function.
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Affiliation(s)
- Clifford R Weiss
- Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, 10 Center Dr, Bldg 10, Rm B1D416, MSC 1061, Bethesda, MD 20892-1061, USA
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Rerkpattanapipat P, Mazur W, Link KM, Hundley WG. Assessment of cardiac function with MR imaging. Magn Reson Imaging Clin N Am 2003; 11:67-80. [PMID: 12797511 DOI: 10.1016/s1064-9689(02)00021-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A variety of black or white blood imaging techniques are available for assessing global and regional LV and RV function during cardiovascular MR imaging examinations. In addition to providing information about LV function at rest, these techniques provide diagnostic and prognostic information regarding myocardial ischemia and viability during MR imaging stress tests.
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Affiliation(s)
- Pairoj Rerkpattanapipat
- Cardiology Section, Wake Forest University School of Medicine, The Bowman Gray Campus, Winston-Salem, NC 27157-1045, USA
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Kitagawa K, Sakuma H, Hirano T, Okamoto S, Makino K, Takeda K. Acute myocardial infarction: myocardial viability assessment in patients early thereafter comparison of contrast-enhanced MR imaging with resting (201)Tl SPECT. Single photon emission computed tomography. Radiology 2003; 226:138-44. [PMID: 12511682 DOI: 10.1148/radiol.2261012108] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To compare contrast material-enhanced magnetic resonance (MR) imaging with resting thallium 201 ((201)Tl) single photon emission computed tomography (SPECT) for predicting myocardial viability in patients early after acute myocardial infarction. MATERIALS AND METHODS Inversion-recovery contrast-enhanced MR images and resting (201)Tl SPECT images were obtained in 22 patients after acute myocardial infarction. The (201)Tl SPECT images were obtained 4.3 days +/- 0.2 (standard error) after the onset of myocardial infarction. Contrast-enhanced MR imaging was performed 7.9 days +/- 1.6 after (201)Tl SPECT. Transmural extent of hyperenhancement on contrast-enhanced MR images and regional (201)Tl activity were quantitatively analyzed with a 12-segment model. Regional wall thickening on follow-up cine MR images obtained 67 days +/- 17 after contrast-enhanced MR imaging was used as an index for myocardial viability. Statistical analyses were performed with the chi(2) and two-tailed Student t tests. RESULTS Both contrast-enhanced MR and resting (201)Tl SPECT images showed significant correlations with regional wall thickening on follow-up cine MR images. The sensitivity, specificity, and accuracy of contrast-enhanced MR imaging in the prediction of viable myocardium were significantly higher than those of resting (201)Tl SPECT (98.0% vs 90.3%, P <.01; 75.0% vs 54.4%, P <.05; and 92.0% vs 81.1%, P <.001, respectively). CONCLUSION Delayed contrast-enhanced MR imaging can help predict myocardial viability as seen on follow-up cine MR images after acute myocardial infarction, with significantly improved sensitivity, specificity, and accuracy in comparison with those of resting (201)Tl SPECT.
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Affiliation(s)
- Kakuya Kitagawa
- Department of Radiology, Matsusaka Central Hospital, Mie, Japan.
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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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Nilsson JC, Nielsen G, Groenning BA, Fritz-Hansen T, Sondergaard L, Jensen GB, Larsson HB. Sustained postinfarction myocardial oedema in humans visualised by magnetic resonance imaging. BRITISH HEART JOURNAL 2001; 85:639-42. [PMID: 11359743 PMCID: PMC1729755 DOI: 10.1136/heart.85.6.639] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To demonstrate postinfarction myocardial oedema in humans with particular reference to the longitudinal course, using magnetic resonance imaging (MRI). DESIGN Prospective observational study. Subjects were studied one week, one month, three months, six months, and one year after presenting with a myocardial infarct. SETTING Cardiology and magnetic resonance departments in a Danish university hospital. PATIENTS 10 patients (three women, seven men), mean (SEM) age 58.2 (3.20) years, with a first transmural myocardial infarct. MAIN OUTCOME MEASURES Location and duration of postinfarction myocardial oedema. RESULTS All patients had signs of postinfarction myocardial oedema. The magnetic resonance images were evaluated by two blinded procedures, employing two MRI and two ECG observers: (1) MRI determined oedema location was compared with the ECG determined site of infarction and almost complete agreement was found; (2) the time course of postinfarction myocardial oedema was explored semiquantitatively, using an image ranking procedure. Myocardial oedema was greatest at the initial examination one week after the infarction, with a gradual decline during the following months (Spearman's rank correlation analysis: rho(observer 1) = 0.94 (p < 0.0001) and rho(observer 2) = 0.97 (p < 0.0001)). The median duration of oedema was six months. CONCLUSIONS Postinfarction myocardial oedema seems surprisingly long lasting. This observation is of potential clinical interest because the oedema may have prognostic significance.
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Affiliation(s)
- J C Nilsson
- Danish Research Centre of Magnetic Resonance, H:S Hvidovre Hospital, University of Copenhagen, Kettegaard Allé 30, DK-2650 Hvidovre, Denmark.
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Kim RJ, Wu E, Rafael A, Chen EL, Parker MA, Simonetti O, Klocke FJ, Bonow RO, Judd RM. The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. N Engl J Med 2000; 343:1445-53. [PMID: 11078769 DOI: 10.1056/nejm200011163432003] [Citation(s) in RCA: 2144] [Impact Index Per Article: 89.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Recent studies indicate that magnetic resonance imaging (MRI) after the administration of contrast material can be used to distinguish between reversible and irreversible myocardial ischemic injury regardless of the extent of wall motion or the age of the infarct. We hypothesized that the results of contrast-enhanced MRI can be used to predict whether regions of abnormal ventricular contraction will improve after revascularization in patients with coronary artery disease. METHODS Gadolinium-enhanced MRI was performed in 50 patients with ventricular dysfunction before they underwent surgical or percutaneous revascularization. The transmural extent of hyperenhanced regions was postulated to represent the transmural extent of nonviable myocardium. The extent of regional contractility at the same locations was determined by cine MRI before and after revascularization in 41 patients. RESULTS Contrast-enhanced MRI showed hyperenhancement of myocardial tissue in 40 of 50 patients before revascularization. In all patients with hyperenhancement the difference in image intensity between hyperenhanced regions and regions without hyperenhancement was more than 6 SD. Before revascularization, 804 of the 2093 myocardial segments analyzed (38 percent) had abnormal contractility, and 694 segments (33 percent) had some areas of hyperenhancement. In an analysis of all 804 dysfunctional segments, the likelihood of improvement in regional contractility after revascularization decreased progressively as the transmural extent of hyperenhancement before revascularization increased (P<0.001). For instance, contractility increased in 256 of 329 segments (78 percent) with no hyperenhancement before revascularization, but in only 1 of 58 segments with hyperenhancement of more than 75 percent of tissue. The percentage of the left ventricle that was both dysfunctional and not hyperenhanced before revascularization was strongly related to the degree of improvement in the global mean wall-motion score (P<0.001) and the ejection fraction (P<0.001) after revascularization. CONCLUSIONS Reversible myocardial dysfunction can be identified by contrast-enhanced MRI before coronary revascularization.
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Affiliation(s)
- R J Kim
- Feinberg Cardiovascular Research Institute, and Department of Medicine, Northwestern University Medical School, Chicago, IL 60611-3008, USA.
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Carreras F, Borrás X, Pons-Lladó G, Llauger J, Palmer J. [Acute myocardial infarct studied by magnetic resonance with gadolinium-DTPA contrast compared to echocardiography]. Rev Esp Cardiol 1999; 52:885-91. [PMID: 10611802 DOI: 10.1016/s0300-8932(99)75019-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES Gadolinium-DTPA used as a contrast agent in magnetic resonance imaging allows the detection and quantification of the necrotic area in acute myocardial infarction. The aim of the present study is to assess the value of this method for the diagnosis of myocardial infarction in comparison with clinical and echocardiographic data. METHODS Contrast magnetic resonance imaging and echocardiographic studies were performed on 16 patients during the first week after admission for acute myocardial infarction. Necrotic and total myocardial mass were calculated from magnetic resonance images and this was compared to the extension of the myocardial infarction assessed by electrocardiography and the peak level of total creatinine-phosphokinase serum enzyme. The number and localization of myocardial segments showing contrast uptake was related to segments with contractile abnormalities at the echocardiographic exam. RESULTS The mean value of the mass of myocardial necrosis calculated from the total area of gadolinium-DTPA uptake in each patient was 25 g (range: 2-67 g), corresponding to 17% of the total myocardial mass (range: 1-45%). This value correlated with the peak serum level of total creatinine-phosphokinase enzyme (r = 0.714; p < 0.003) and with the number of Q waves present at the electrocardiogram (r = 0.69; p < 0.005). A very good agreement between the location of the myocardial infarction by ECG, echocardiography and magnetic resonance was evidenced, and a satisfactory correlation existed between myocardial segments with gadolinium-DTPA uptake and akinetic echocardiographic segments (kappa = 0.65). CONCLUSIONS The detection and quantitation of the necrotic area in the acute myocardial infarction with gadolinium-DTPA contrast magnetic resonance shows a good correlation with clinical and echocardiographic data.
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Affiliation(s)
- F Carreras
- Departamento de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona.
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Abstract
Advances in magnetic resonance imaging (MRI) have led to more widespread utilization of this diagnostic imaging modality in the diagnosis of coronary artery disease. With MRI, the complexity and heterogeneity of myocardial infarcts can be demonstrated. By using this technique, much insight has been gained into the pathophysiologic mechanisms of acute coronary thrombosis and reperfusion. MRI has significant diagnostic potential, particularly if one can combine studies of myocardial function, perfusion, and sodium metabolism with the noninvasive assessment of coronary anatomy and epicardial coronary artery blood flow.
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Affiliation(s)
- K C Wu
- Division of Cardiology, Johns Hopkins University Hospital, Baltimore, Maryland 21287, USA
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Dendale P, Franken PR, Block P, Pratikakis Y, De Roos A. Contrast enhanced and functional magnetic resonance imaging for the detection of viable myocardium after infarction. Am Heart J 1998; 135:875-80. [PMID: 9588420 DOI: 10.1016/s0002-8703(98)70049-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Viable myocardium after acute myocardial infarction may be characterized by magnetic resonance imaging (MRI) either by demonstration of recovery of wall motion under dobutamine stress or by perfusion patterns after contrast medium administration. This study examines the relation between the two techniques. MATERIALS AND METHODS Gradient-echo MRI at rest and under low-dose dobutamine stress was performed in 28 patients within the first 2 weeks after acute myocardial infarction. In addition, spin-echo MRI was performed after gadolinium-DOTA administration. Wall motion at rest and under stress was scored to assess the contractile reserve of the infarct regions. Infarct enhancement patterns were classified as subendocardial, transmural, or as a doughnut pattern. RESULT Subendocardial or absent infarct enhancement was related to functional recovery under stress in 31 of 37 infarct segments. Transmural infarct enhancement was correlated with the absence of functional recovery in 10 of 17 infarct segments (p < 0.002), indicating nonviability. The doughnut pattern was exclusively associated with the absence of viability (five of five). CONCLUSION Contrast enhancement patterns are related to residual myocardial viability.
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Affiliation(s)
- P Dendale
- Department of Cardiology, Free University of Brussels (VUB), Belgium
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Wu KC, Zerhouni EA, Judd RM, Lugo-Olivieri CH, Barouch LA, Schulman SP, Blumenthal RS, Lima JA. Prognostic significance of microvascular obstruction by magnetic resonance imaging in patients with acute myocardial infarction. Circulation 1998; 97:765-72. [PMID: 9498540 DOI: 10.1161/01.cir.97.8.765] [Citation(s) in RCA: 1025] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The extent of microvascular obstruction during acute coronary occlusion may determine the eventual magnitude of myocardial damage and thus, patient prognosis after infarction. By contrast-enhanced MRI, regions of profound microvascular obstruction at the infarct core are hypoenhanced and correspond to greater myocardial damage acutely. We investigated whether profound microvascular obstruction after infarction predicts 2-year cardiovascular morbidity and mortality. METHODS AND RESULTS Forty-four patients underwent MRI 10 +/- 6 days after infarction. Microvascular obstruction was defined as hypoenhancement seen 1 to 2 minutes after contrast injection. Infarct size was assessed as percent left ventricular mass hyperenhanced 5 to 10 minutes after contrast. Patients were followed clinically for 16 +/- 5 months. Seventeen patients returned 6 months after infarction for repeat MRI. Patients with microvascular obstruction (n = 11) had more cardiovascular events than those without (45% versus 9%; P=.016). In fact, microvascular status predicted occurrence of cardiovascular complications (chi2 = 6.46, P<.01). The risk of adverse events increased with infarct extent (30%, 43%, and 71% for small [n = 10], midsized [n = 14], and large [n = 14] infarcts, P<.05). Even after infarct size was controlled for, the presence of microvascular obstruction remained a prognostic marker of postinfarction complications (chi2 = 5.17, P<.05). Among those returning for follow-up imaging, the presence of microvascular obstruction was associated with fibrous scar formation (chi2 = 10.0, P<.01) and left ventricular remodeling (P<.05). CONCLUSIONS After infarction, MRI-determined microvascular obstruction predicts more frequent cardiovascular complications. In addition, infarct size determined by MRI also relates directly to long-term prognosis in patients with acute myocardial infarction. Moreover, microvascular status remains a strong prognostic marker even after control for infarct size.
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Affiliation(s)
- K C Wu
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Md, USA
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Keijer JT, Bax JJ, van Rossum AC, Visser FC, Visser CA. Myocardial perfusion imaging: clinical experience and recent progress in radionuclide scintigraphy and magnetic resonance imaging. INTERNATIONAL JOURNAL OF CARDIAC IMAGING 1997; 13:415-31. [PMID: 9360178 DOI: 10.1023/a:1005737725964] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In the past 20 years, radionuclide scintigraphy has proven to be a sensitive clinical tool in the assessment of myocardial perfusion abnormalities. Magnetic resonance imaging may also be used to study myocardial perfusion, but its potential value still has to emerge in the clinical setting. This review addresses the potential and achievements of both methods in clinical cardiology.
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Affiliation(s)
- J T Keijer
- Department of Cardiology, Free University Hospital, Amsterdam, The Netherlands
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van der Wall EE, van Rugge FP, Vliegen HW, Reiber JH, de Roos A, Bruschke AV. Ischemic heart disease: value of MR techniques. INTERNATIONAL JOURNAL OF CARDIAC IMAGING 1997; 13:179-89. [PMID: 9220280 DOI: 10.1023/a:1005871614387] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The cardiovascular applications of magnetic resonance (MR) techniques in coronary artery disease have increased considerably in recent years. Technical advantages of MR imaging are the excellent spatial resolution, the characterization of myocardial tissue, and the potential for three-dimensional imaging. These characteristics allow the accurate assessment of left ventricular mass and volume, the differentiation of infarcted from normal tissue, and the determination of systolic wall thickening and regional wall motion abnormalities. METHODS In addition to the conventionally used spin-echo and cine-echo techniques, newer techniques such as myocardial tagging, ultrafast MR imaging and MR coronary angiography have been developed. These newer techniques allow a more accurate assessment of ventricular function (tagging), myocardial perfusion (ultrafast imaging), and evaluation of stenosis severity (MR coronary angiography). Particularly early detection and flow assessment of stenosed coronary arteries and bypasses by MR angiography would constitute a major breakthrough in cardiovascular MR imaging. Apart from the MR imaging techniques, cardiac metabolism may be well assessed using MR spectroscopy. This provides unique information on the metabolic behaviour of the myocardium under conditions stress-induced ischemia. However, the definite niche of cardiac MR spectroscopy has still to be settled. CONCLUSION Currently, MR techniques allow the evaluation of anatomy and function (accepted use), perfusion and viability (development phase), and coronary angiography (experimental phase). A particular strength of MR imaging is that one single MR test may encompass cardiac anatomy, perfusion, function, metabolism and coronary angiography. The replacement of multiple diagnostic tests with one MR test may have major effects on cardiovascular healthcare economics and would outweight the cost inherent to the MR angiography procedure.
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Affiliation(s)
- E E van der Wall
- Department of Cardiology, Leiden University Medical Centre, The Netherlands
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Kim RJ, Chen EL, Lima JA, Judd RM. Myocardial Gd-DTPA kinetics determine MRI contrast enhancement and reflect the extent and severity of myocardial injury after acute reperfused infarction. Circulation 1996; 94:3318-26. [PMID: 8989146 DOI: 10.1161/01.cir.94.12.3318] [Citation(s) in RCA: 466] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Contrast medium-enhanced magnetic resonance images of acute, reperfused infarcts have shown hypoenhanced and hyperenhanced regions in areas of injured myocardium. The precise mechanisms that lead to these altered enhancement patterns are unknown. This study was designed to evaluate possible mechanisms and to relate altered enhancement patterns to myocardial perfusion and viability. METHODS AND RESULTS Thirteen rabbits underwent in situ coronary artery occlusion and reperfusion followed by isolated perfusion with cardioplegic solution. T1-weighted spin-echo images were acquired continuously during step changes in perfusate Gd-DTPA concentration. Regional blood flow was also measured by use of radioactive microspheres in all rabbits. There were marked differences in Gd-DTPA wash-in and washout time constants (wash-in, 0.8 +/- 0.1, 2.1 +/- 02, and 16.3 +/- 2.4 minutes, P < .001; washout, 1.6 +/- 0.1, 4.8 +/- 0.5, and 31.1 +/- 3.3 minutes, P < .001) in normal, infarct rim, and infarct core regions, respectively, resulting in differential enhancement of these regions. Microsphere flows in the infarct rim and core were 42.9 +/- 4.0% and 12.0 +/- 1.6% of normal myocardium and correlated well with washout time constants (r = .86, y = 0.77x - 0.002, P < .001), suggesting that these time constants index the severity of microvascular damage. In addition, spatial maps of washout time constants were produced. The extent of regions with abnormal time constants correlated well with triphenyltetrazolium chloride-determined infarct size (r = .94, y = 0.95x + 4.17, P < .001). CONCLUSIONS In contrast-enhanced magnetic resonance images of acute, reperfused rabbit infarcts, differential image intensity is primarily due to regional differences in contrast agent wash-in and washout time constants. These regional differences in time constants also indicate the extent and severity of myocardial injury.
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Affiliation(s)
- R J Kim
- Department of Medicine, Johns Hopkins Hospital, Baltimore, Md 21287-6568, USA.
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van der Wall EE, Vliegen HW, de Roos A, Bruschke AV. Magnetic resonance techniques for assessment of myocardial viability. J Cardiovasc Pharmacol 1996; 28 Suppl 1:S37-44. [PMID: 8891869 DOI: 10.1097/00005344-199600003-00006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In general, the following three standards for myocardial viability can be used: (a) preserved coronary flow (adequate perfusion); (b) preserved wall motion (systolic wall thickening); and (c) preserved metabolism (metabolic integrity). The current magnetic resonance (MR) techniques provide a great potential to measure all three standards of viability. Adequate perfusion can be assessed by spin-echo MR imaging and/or ultrafast MR imaging, systolic wall thickening by cine MR imaging, and the presence of metabolic integrity can be determined by MR spectroscopy. These noninvasive and versatile techniques have led to an increasing interest and research in recent years. Particular strengths of the MR techniques are: the inherent three-dimensional data acquisition without radiation exposure; the intrinsic soft-tissue contrast that allows tissue characterization; the excellent spatial resolution (in the 1- to 2-mm range), which permits the evaluation of regional abnormalities; multitomographic imaging capabilities that allow acquisition of cardiac images in any plane; the inherent sensitivity to blood and wall motion; and the potential for in vivo measurement of myocardial metabolism using MR spectroscopy. This review article demonstrates that MR techniques might play a growing role in the assessment of myocardial viability.
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Affiliation(s)
- E E van der Wall
- Department of Cardiology, University Hospital Leiden, The Netherlands
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