Characterizing Myocardial Edema and Hemorrhage Using Quantitative T2 and T2* Mapping at Multiple Time Intervals Post ST-Segment Elevation Myocardial Infarction

Zia, Mohammad I.; Ghugre, Nilesh R.; Connelly, Kim A.; Strauss, Bradley H.; Sparkes, John D.; Dick, Alexander; Wright, Graham A.

doi:10.1161/circimaging.112.973222

Cited by 107 publications

(90 citation statements)

References 31 publications

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“…Edema in remote myocardium is supported by previous findings of higher T2 of remote myocardium after AMI in pigs [27, 28]. Also, two studies have demonstrated a reduction in remote T2 values in patients with AMI, paralleling the changes in native T1 over time observed in our study [11, 29]. …”

Section: Discussionsupporting

confidence: 91%

Changes in remote myocardial tissue after acute myocardial infarction and its relation to cardiac remodeling: A CMR T1 mapping study

et al. 2017

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ObjectivesTo characterize the temporal alterations in native T1 and extracellular volume (ECV) of remote myocardium after acute myocardial infarction (AMI), and to explore their relation to left ventricular (LV) remodeling.MethodsForty-two patients with AMI successfully treated with primary PCI underwent cardiovascular magnetic resonance after 4–6 days and 3 months. Cine imaging, late gadolinium enhancement, and T1-mapping (MOLLI) was performed at 1.5T. T1 values were measured in the myocardial tissue opposite of the infarct area. Myocardial ECV was calculated from native- and post-contrast T1 values in 35 patients, using a correction for synthetic hematocrit.ResultsNative T1 of remote myocardium significantly decreased between baseline and follow-up (1002 ± 39 to 985 ± 30ms, p<0.01). High remote native T1 at baseline was independently associated with a high C-reactive protein level (standardized Beta 0.32, p = 0.04) and the presence of microvascular injury (standardized Beta 0.34, p = 0.03). ECV of remote myocardium significantly decreased over time in patients with no LV dilatation (29 ± 3.8 to 27 ± 2.3%, p<0.01). In patients with LV dilatation, remote ECV remained similar over time, and was significantly higher at follow-up compared to patients without LV dilatation (30 ± 2.0 versus 27 ± 2.3%, p = 0.03).ConclusionsIn reperfused first-time AMI patients, native T1 of remote myocardium decreased from baseline to follow-up. ECV of remote myocardium decreased over time in patients with no LV dilatation, but remained elevated at follow-up in those who developed LV dilatation. Findings from this study may add to an increased understanding of the pathophysiological mechanisms of cardiac remodeling after AMI.

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Section: Discussionsupporting

confidence: 91%

Changes in remote myocardial tissue after acute myocardial infarction and its relation to cardiac remodeling: A CMR T1 mapping study

et al. 2017

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“…Cardiac magnetic resonance (MR) imaging based on either T2*-weighted (16,18,(21)(22)(23)(24) or T2-weighted (15,17, Implication for Patient Care n The occurrence of myocardial reperfusion hemorrhage, which has been associated with acute myocardial damage and adverse chronic remodeling, is expected to be more reliably assessed with T2* cardiac MR imaging than with T2-based cardiac MR imaging.…”

Section: Patient Studiesmentioning

confidence: 99%

Detection of Acute Reperfusion Myocardial Hemorrhage with Cardiac MR Imaging: T2 versus T2*

Kali

Tang²,

Kumar³

et al. 2013

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Purpose:To evaluate T2 and T2* changes in acute reperfused hemorrhagic and nonhemorrhagic myocardial infarctions and to determine which technique is more suitable in the detection of intramyocardial hemorrhage at 1.5 T. Materials and Methods:Patient studies were approved by the institutional review board and were HIPAA compliant. Patients (n = 14, three women) with first ST-elevation myocardial infarction underwent cardiac magnetic resonance (MR) imaging 3 days after angioplasty. T2* maps, T2 short inversion time inversion-recovery (STIR) images, and late gadolinium enhancement (LGE) images were acquired. Animal studies were approved by the institutional animal care and use committee. Canines (n = 20) were subjected to ischemia-reperfusion injury, and cardiac MR imaging was performed 5 days after reperfusion. T2* and T2 maps and T2 STIR and LGE images were acquired. Repeated-measures analysis of variance or the Friedman test was used to compare T2 and T2* changes in patients with hemorrhagic infarctions and those with nonhemorrhagic infarctions. Results:Relative to remote myocardium, mean T2* of hemorrhagic infarctions was 54% 6 13 (standard deviation) lower in patients (15.9 msec 6 4.5 vs 35.2 msec 6 2.1, P , .001) and 40% 6 10 lower in canines (23.0 msec 6 4.0 vs 39.3 msec 6 2.5, P , .001). Mean T2* of nonhemorrhagic infarctions was marginally elevated by 6% 6 2.5 (37.8 msec 6 2.5, P = .021) in patients and by 8% 6 5 (44.6 msec 6 4.8, P = .012) in canines. In contrast, mean T2 STIR signal intensity (SI) of both hemorrhagic infarctions and nonhemorrhagic infarctions was higher than that in remote myocardium both in patients (hemorrhagic: 37% 6 19, P , .001; nonhemorrhagic: 78% 6 27, P , .001) and in canines (hemorrhagic: 42% 6 22, P , .001; nonhemorrhagic: 65% 6 22, P , .001). Consistent with STIR SI findings, mean T2 of both hemorrhagic (62.0 msec 6 4.9) and nonhemorrhagic (71.7 msec 6 7.3) infarctions in canines was elevated relative to mean T2 of remote myocardium (52.1 msec 6 4.8) by 18% 6 9 and 38% 6 13, respectively (P , .001 for both). Conclusion

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“…These imaging techniques aim at identifying the mean relaxation values within a given voxel by determining its SI curve in response to the sole variation of inversion time on T1-weighted imaging for T1 relaxometry, echo time on fast spin echo T2-weighted imaging for T2 relaxometry and echo time on gradient echo T2-weighted imaging for T2* relaxometry. At 1.5 T, mean values of myocardial relaxation T1 shortening and T2 lengthening are hallmarks of edema [29,30], whereas shortening of the T2* relaxation identifies hemorrhage [31].…”

Section: Vt During Epsmentioning

confidence: 99%

Value of cardiac MRI to evaluate ischemia-related ventricular arrhythmia substrates

Nchimi

Davin

Georgiopoulos

et al. 2015

Expert Review of Cardiovascular Therapy

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During the course of and after a myocardial ischemia-reperfusion insult, ventricular arrhythmia (VA) may have several single or overlapping potential substrates. Some of these may not be associated with morphological and functional changes, whereas others may have individual susceptibility. Nevertheless, cardiac magnetic resonance currently offers a comprehensive and highly effective toolset for the evaluation of a risk of VA on a patient basis after a myocardial infarction. Indeed, cardiac magnetic resonance has established itself as a reference for the evaluation of the myocardial function and properties, using respectively, cine and tissue characterization imaging to detect and evaluate the extent of acute myocardial injuries, scars and remodeling. This article describes and discusses imaging strategies used to evaluate the substrates for VA in the setting of a myocardial infarction.

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Characterizing Myocardial Edema and Hemorrhage Using Quantitative T2 and T2* Mapping at Multiple Time Intervals Post ST-Segment Elevation Myocardial Infarction

Cited by 107 publications

References 31 publications

Changes in remote myocardial tissue after acute myocardial infarction and its relation to cardiac remodeling: A CMR T1 mapping study

Changes in remote myocardial tissue after acute myocardial infarction and its relation to cardiac remodeling: A CMR T1 mapping study

Detection of Acute Reperfusion Myocardial Hemorrhage with Cardiac MR Imaging: T2 versus T2*

Value of cardiac MRI to evaluate ischemia-related ventricular arrhythmia substrates

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