Delayed Enhancement and T2-Weighted Cardiovascular Magnetic Resonance Imaging Differentiate Acute From Chronic Myocardial Infarction

Abdel-Aty, Hassan; Zagrosek, Anja; Schulz‐Menger, Jeanette; Taylor, Andrew J.; Messroghli, Daniel; Kumar, Andreas; Groß, Michael; Dietz, Rainer; Friedrich, Matthias G.

doi:10.1161/01.cir.0000127428.10985.c6

Cited by 473 publications

(194 citation statements)

References 29 publications

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“…T2-weighted CMR is ambiguously sensitive to chronic MI, with no observed increase in signal intensity or T2 relaxation at the site of infarct [6] or changes in T2 that were dependent on the location of infarction [26]. These mixed results would reinforce the hypothesis that there are low frequency relaxation mechanisms unrelated to disease that obscure contrast [7].…”

Section: Discussionmentioning

confidence: 99%

“…Myocardial tissue relaxation mechanisms, T2 and T1, are generally observed not to be as effective as LGE to discriminate chronic MI characterized by fibrotic scar tissue [6]. The additional relaxation rate contribution from local magnetic fields, water diffusion through magnetic field gradients among other mechanisms, may obfuscate intrinsic T2-weighted contrast mechanisms for detection of MI [7].…”

Section: Introductionmentioning

confidence: 99%

“…The additional relaxation rate contribution from local magnetic fields, water diffusion through magnetic field gradients among other mechanisms, may obfuscate intrinsic T2-weighted contrast mechanisms for detection of MI [7]. In several studies, there was little or no discriminating ability of T2 to detect chronic MI [6]. Alternative endogenous contrast methods based on T1ρ CMR and spin locking have shown some potential in patients to detect acute MI [8,9], but there have been no T1ρ CMR studies of chronic MI in vivo.…”

Section: Introductionmentioning

confidence: 99%

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In vivo chronic myocardial infarction characterization by spin locked cardiovascular magnetic resonance

Witschey

Zsido

Koomalsingh

et al. 2012

Journal of Cardiovascular Magnetic Resonance

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BackgroundLate 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.Methods7Yorkshire 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.ResultsMean 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.ConclusionsT1ρ-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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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In vivo chronic myocardial infarction characterization by spin locked cardiovascular magnetic resonance

Witschey

Zsido

Koomalsingh

et al. 2012

Journal of Cardiovascular Magnetic Resonance

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“…Area at risk was assessed as edema on the initial scan using a T 2 ‐weighted short tau inversion‐recovery sequence 21, 26. LV volume, function, and mass were measured on both CMR examinations using a standard ECG‐triggered balanced steady‐state free‐precession cine sequence.…”

Section: Methodsmentioning

confidence: 99%

Left Ventricular Hypertrophy Is Associated With Increased Infarct Size and Decreased Myocardial Salvage in Patients With ST‐Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Nepper‐Christensen

Lønborg

Ahtarovski

et al. 2017

JAHA

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BackgroundApproximately one third of patients with ST‐segment elevation myocardial infarction (STEMI) have left ventricular hypertrophy (LVH), which is associated with impaired outcome. However, the causal association between LVH and outcome in STEMI is unknown. We evaluated the association between LVH and: myocardial infarct size, area at risk, myocardial salvage, microvascular obstruction, left ventricular (LV) function (all determined by cardiac magnetic resonance [CMR]), and all‐cause mortality and readmission for heart failure in STEMI patients treated with primary percutaneous coronary intervention.Methods and ResultsIn this substudy of the DANAMI‐3 trial, 764 patients underwent CMR. LVH was defined by CMR and considered present if LV mass exceeded 77 (men) and 67 g/m2 (women). One hundred seventy‐eight patients (24%) had LVH. LVH was associated with a larger final infarct size (15% [interquartile range {IQR}, 10–21] vs 9% [IQR, 3–17]; P<0.001) and smaller final myocardial salvage index (0.6 [IQR, 0.5–0.7] vs 0.7 [IQR, 0.5–0.9]; P<0.001). The LVH group had a higher incidence of microvascular obstruction (66% vs 45%; P<0.001) and lower final LV ejection fraction (LVEF; 53% [IQR, 47–60] vs 61% [IQR, 55–65]; P<0.001). In a Cox regression analysis, LVH was associated with a higher risk of all‐cause mortality and readmission for heart failure (hazard ratio 2.59 [95% CI, 1.38–4.90], P=0.003). The results remained statistically significant in multivariable models.ConclusionsLVH is independently associated with larger infarct size, less myocardial salvage, higher incidence of microvascular obstruction, lower LVEF, and a higher risk of all‐cause mortality and incidence of heart failure in STEMI patients treated with primary percutaneous coronary intervention.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT01435408.

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“…It is used for differentiation of acute from chronic MI [2], assessment of the area-at-risk [3,4], myocarditis [5] and increasingly as a surrogate end-point in clinical trials [6]. …”

Section: Introductionmentioning

confidence: 99%

Non-contrast T1-mapping detects acute myocardial edema with high diagnostic accuracy: a comparison to T2-weighted cardiovascular magnetic resonance

Ferreira

Piechnik

Dall’Armellina

et al. 2012

Journal of Cardiovascular Magnetic Resonance

392

310

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BackgroundT2w-CMR is used widely to assess myocardial edema. Quantitative T1-mapping is also sensitive to changes in free water content. We hypothesized that T1-mapping would have a higher diagnostic performance in detecting acute edema than dark-blood and bright-blood T2w-CMR.MethodsWe investigated 21 controls (55 ± 13 years) and 21 patients (61 ± 10 years) with Takotsubo cardiomyopathy or acute regional myocardial edema without infarction. CMR performed within 7 days included cine, T1-mapping using ShMOLLI, dark-blood T2-STIR, bright-blood ACUT2E and LGE imaging. We analyzed wall motion, myocardial T1 values and T2 signal intensity (SI) ratio relative to both skeletal muscle and remote myocardium.ResultsAll patients had acute cardiac symptoms, increased Troponin I (0.15-36.80 ug/L) and acute wall motion abnormalities but no LGE. T1 was increased in patient segments with abnormal and normal wall motion compared to controls (1113 ± 94 ms, 1029 ± 59 ms and 944 ± 17 ms, respectively; p < 0.001). T2 SI ratio using STIR and ACUT2E was also increased in patient segments with abnormal and normal wall motion compared to controls (all p < 0.02). Receiver operator characteristics analysis showed that T1-mapping had a significantly larger area-under-the-curve (AUC = 0.94) compared to T2-weighted methods, whether the reference ROI was skeletal muscle or remote myocardium (AUC = 0.58-0.89; p < 0.03). A T1 value of greater than 990 ms most optimally differentiated segments affected by edema from normal segments at 1.5 T, with a sensitivity and specificity of 92 %.ConclusionsNon-contrast T1-mapping using ShMOLLI is a novel method for objectively detecting myocardial edema with a high diagnostic performance. T1-mapping may serve as a complementary technique to T2-weighted imaging for assessing myocardial edema in ischemic and non-ischemic heart disease, such as quantifying area-at-risk and diagnosing myocarditis.

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Delayed Enhancement and T2-Weighted Cardiovascular Magnetic Resonance Imaging Differentiate Acute From Chronic Myocardial Infarction

Cited by 473 publications

References 29 publications

In vivo chronic myocardial infarction characterization by spin locked cardiovascular magnetic resonance

In vivo chronic myocardial infarction characterization by spin locked cardiovascular magnetic resonance

Left Ventricular Hypertrophy Is Associated With Increased Infarct Size and Decreased Myocardial Salvage in Patients With ST‐Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Non-contrast T1-mapping detects acute myocardial edema with high diagnostic accuracy: a comparison to T2-weighted cardiovascular magnetic resonance

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