Appearance of microvascular obstruction on high resolution first-pass perfusion, early and late gadolinium enhancement CMR in patients with acute myocardial infarction

Mather, Adam N; Lockie, Tim; Nagel, Eike; Marber, Michael; Perera, Divaka; Redwood, Simon; Radjenovic, Aleksandra; Saha, Abhijeet; Greenwood, John P; Plein, Sven

doi:10.1186/1532-429x-11-33

Cited by 80 publications

(53 citation statements)

References 32 publications

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“…The Hypo was clearly visualized on ceSSFP imaging, possibly because of the sensitivity of ceSSFP to marked decreases in water content and perfusion. 22 ceSSFP imaging also showed the LVOT jet flow with the cine mode. Visualized using the present ceSSFP technique, the jet flow may be consistent with the LVOT pressure gradient.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, we derived interpretations of MR images about ASA-induced MI, MVO, and dense scarring from findings reported of previous studies. 13,14,[19][20][21][22] In conclusion, ceSSFP can sufficiently demonstrate myocardial injuries induced by ASA despite its lower image contrast than that of LGE MR imaging. In addition, the ceSSFP technique allows for the assessment of LVOT jet flow in a single scan and can be incorporated into a routine protocol in patients with HOCM after ASA without penalty, such as the increased scan time and decreased contrast of cine SSFP.…”

Section: Discussionmentioning

confidence: 99%

“…21 The ceSSFP imaging acquired 3 to 7 min after gadolinium injection may reflect an expanded interstitial space or hyperemia in addition to tissue edema. [11][12][13]16,22 These factors may have contributed to the feasibility of ceSSFP for visualizing both MI and MVO following ASA. On the other hand, we could visualize MI 11, 12 We used no preparation pulse, such as T 2 -preparation or black-blood pulse, 11,12 to improve visualization of myocardial edema on routine cine SSFP.…”

Section: Discussionmentioning

confidence: 99%

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Contrast-enhanced Steady-state Free Precession in the Assessment of Hypertrophic Obstructive Cardiomyopathy after Alcohol Septal Ablation

et al. 2016

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Purpose: We evaluated the feasibility of contrast-enhanced steady-state free precession (ceSSFP) in the assessment of myocardial injury and obstruction of the left ventricular outflow tract (LVOT) in patients with hypertrophic obstructive cardiomyopathy (HOCM) after alcohol septal ablation (ASA).Methods: Twelve patients with HOCM underwent 16 magnetic resonance (MR) examinations following ASA. Precontrast SSFP, ceSSFP and late gadolinium enhancement (LGE) imaging were performed with a 1.5-tesla imager. ceSSFP was performed 3 to 7 min after gadolinium injection. We visually and quantitatively evaluated the signal patterns of the myocardium after ASA on SSFP and LGE MR imaging. We observed the LVOT using ceSSFP in the 3-chamber view.Results: We could visualize ASA-induced myocardial infarction (MI) in all 16 studies by LGE and ceSSFP but in only 6 studies (37.5%) by precontrast SSFP. Contrast was higher between MI and remote myocardium with LGE than ceSSFP (P < 0.01). ASA-induced hypointense regions were well visualized by the 2 sequences after contrast in the 7 patients who underwent MR imaging within 7 weeks of ASA and in a few patients after 80 weeks from ASA. The ceSSFP allowed comparable visualization of the jet flow crossing the LVOT to that derived from echocardiographic data.Conclusion: Contrast-enhanced steady-state free precession allows assessment of myocardial injury as well as of the left ventricular outflow tract after alcohol septal ablation in a single scan without penalty in scan time and cine imaging contrast.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Contrast-enhanced Steady-state Free Precession in the Assessment of Hypertrophic Obstructive Cardiomyopathy after Alcohol Septal Ablation

et al. 2016

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“…dial scars may be surrounded to a variable extent by tissues with impaired microvasculature (24,25). There is, to the best of our knowledge, no available data in the literature evaluating specifically how to differentiate microvascular from macrovascular obstruction in a LCEMR-DCEMR mismatch, resulting into systematic and potentially excessive referrals to catheter coronary angiography.…”

Section: Cardiomyopathiesmentioning

confidence: 96%

Review article: Myocardial dynamic contrast-enhanced MR : vascular diseases and beyond

Nchimi

Djekic²,

Raskinet³

et al. 2014

Journal of the Belgian Society of Radiology

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Contrast-enhanced cardiac magnetic resonance imaging allows the evaluation of both myocardial perfusion and myocardial tissue characteristics. This paper reviews different microvascular and non-vascular conditions that can cause abnormal findings on contrast-enhanced myocardial magnetic resonance imaging. Knowledge of their characteristics can avoid misinterpretation and avoid inappropriate referral for further invasive imaging in patients suspected of myocardial vascular disease. Key-word: Myocardium, MR.From: 1.

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“…MO can be directly visualized by cardiac magnetic resonance imaging (MRI) (1)(2)(3)(4). The exact pathophysiology of MO remains unclear; however, a no-reflow area as a result of capillary obstruction due to myocardial necrosis or distal embolization after primary percutaneous coronary intervention (PCI) is being discussed (5).…”

mentioning

confidence: 99%

Temporal course of microvascular obstruction after myocardial infarction assessed by MRI

Abanador-Kamper

Karamani

Kamper³

et al. 2016

Diagn Interv Radiol

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M icrovascular obstruction (MO) appears as a no-reflow area due to reperfusion after a prolonged myocardial ischemia. MO can be directly visualized by cardiac magnetic resonance imaging (MRI) (1-4). The exact pathophysiology of MO remains unclear; however, a no-reflow area as a result of capillary obstruction due to myocardial necrosis or distal embolization after primary percutaneous coronary intervention (PCI) is being discussed (5). MO is observed in patients with ST-elevated myocardial infarction (STEMI) and non ST-elevated myocardial infarction (NSTEMI). The fact that MO is observed in both successfully and unsuccessfully reperfused myocardium underlines the hypothesis of myocardial tissue hypoperfusion despite a patent culprit lesion (5, 6). The presence of MO has been associated with an increased risk for left ventricular remodeling, rehospitalization, reinfarction, and death and is therefore a strong prognostic marker (3, 7-10).Some authors distinguished between early and late MO, differentiated by the period between gadolinium injection and image acquisition (9, 11). These studies identified late or persistent MO after 15 minutes as a stronger prognostic factor after acute myocardial infarction (9).There are only a few studies on time-dependent changes of MO, predominantly with animal data. Most of these studies analyzed the extent of MO after reperfusion in the acute phase of myocardial ischemia (2,11,12). Data on long-term course of MO are lacking, so far.The objective of this study was to assess the follow-up of MO in patients after acute myocardial infarction. Methods Study populationWe identified 31 patients with MO after acute myocardial infarction and primary PCI by cardiac MRI. Patients were eligible if they had ST-segment elevation of at least 0. PURPOSEWe aimed to analyze the extent of microvascular obstruction (MO) after the index event compared with the follow-up at a median of three months. METHODSWe identified 31 patients with MO after primary percutaneous coronary intervention of acute myocardial infarction by cardiac magnetic resonance imaging. The initial examination was performed after the index event, and 27 patients had the follow-up exam after a median of three months (interquartile range, 2-4 months). In addition, we examined 10 patients without MO after transmural myocardial infarction, as a control group. RESULTSMO disappeared in 23 of 27 patients (85%) in the follow-up and transformed into transmural late gadolinium enhancement. In patients with persistent MO, mean MO size decreased from 2.25% to 1.25%. In patients with MO, mean infarct size decreased significantly from 20.8% to 14.7% (P < 0.001). In the control group, mean infarct size decreased from 12.7% to 10.5% in the follow-up scan (P = 0.137). CONCLUSIONMO is significantly reduced during the follow-up after acute myocardial infarction.

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Appearance of microvascular obstruction on high resolution first-pass perfusion, early and late gadolinium enhancement CMR in patients with acute myocardial infarction

Cited by 80 publications

References 32 publications

Contrast-enhanced Steady-state Free Precession in the Assessment of Hypertrophic Obstructive Cardiomyopathy after Alcohol Septal Ablation

Contrast-enhanced Steady-state Free Precession in the Assessment of Hypertrophic Obstructive Cardiomyopathy after Alcohol Septal Ablation

Review article: Myocardial dynamic contrast-enhanced MR : vascular diseases and beyond

Temporal course of microvascular obstruction after myocardial infarction assessed by MRI

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