Assessment of Circumferential Endocardial Extent of Myocardial Edema and Infarction in Patients With Reperfused Acute Myocardial Infarction

Abstract

SummaryT2 weighted (T2W) images on cardiovascular magnetic resonance (CMR) visualizes myocardial edema, which refl ects the myocardial area at risk (AAR) in reperfused acute myocardial infarction (AMI). Late gadolinium enhancement (LGE) demonstrates myocardial infarction.LGE images cover the whole left ventricle, but T2W images are obtained from a few slices of the left ventricle due to the long sequence time, so the quantifi cation of AAR of the entire left ventricle is diffi cult. We hypothesize that we can quantify AAR with only LGE images if there is a strong correlation between the circumferential endocardial extent of myocardial edema and infarction. Thirty patients with fi rst AMI were enrolled. All patients underwent successfully reperfusion therapy and CMR was performed within the fi rst week after the event.We measured the circumferential extent of edema and infarction on short-axis views (T2 angle and LGE angle), respectively. A total of 82 short-axis slices showed transmural edema on T2W images. Corresponding LGE images were ana- L ate gadolinium enhancement (LGE) with cardiovascular magnetic resonance imaging (CMR) can accurately detect myocardial infarction in vivo. [1][2][3][4] On the other hand, it has been shown that T2-weighted (T2W) images can demonstrate myocardial edema as an area of hyperintense signal.5,6) Aletras, et al established the concept that the area of hyperintense signal (edematous myocardium) on T2W images refl ects the myocardial area at risk (AAR) in reperfused acute myocardial infarction (AMI). 7) Thus, comparing the extent of LGE with the one of T2W AAR makes it possible to determine the proportion of myocardium that has been salvaged. However, covering the whole left ventricle with T2W images is very time consuming, which is undesirable in the setting of AMI. Therefore, the quantifi cation of AAR by T2W images in the whole left ventricle is not feasible in clinical practice.Acute occlusion of a coronary artery initiates an expanding process of myocardial edema, myocardial infarction follows, which spreads from the endocardium to the epicardium as the duration of ischemia increases. 8,9) This is referred to as the wavefront phenomenon.8) According to this pathophysiological basis, the myocardial edema and infarction probably progress transmurally with same endocardial extension. However, the relationship between the circumferential endocardial extent of myocardial edema and infarction in patients with reperfused AMI has not yet been evaluated.We hypothesize that we can quantify AAR with only LGE images if there is signifi cant correlation between the circumferential endocardial extent of myocardial edema on T2W images and infarction on LGE images in the short-axis view.The aim of the present study was to compare the circumferential endocardial extent of myocardial edema and infarction in the short-axis view in patients with reperfused AMI using T2W and LGE CMR.From the

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