Edema as a Very Early Marker for Acute Myocardial Ischemia

Abdel-Aty, Hassan; Cocker, Myra; Meek, Cheryl; Tyberg, John V.; Friedrich, Matthias G.

doi:10.1016/j.jacc.2008.10.065

Cited by 202 publications

(135 citation statements)

References 22 publications

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“…However, despite a hyperintense signal on T2W images approximately 30 minutes after the coronary occlusion, no LGE was found in some dogs. 19) Thus, if early reperfusion is achieved in the situation of acute coronary occlusion, there might be an absence of LGE on CMR. This is referred to as aborted infarction.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2014

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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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Section: Discussionmentioning

confidence: 99%

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

et al. 2014

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“…In AMI patients, bright myocardium on T 2 -weighted imaging reflects the myocardium at risk. 31 Edema changes are most evident in the acute or subacute phase at least up to 1 week after the acute event, 30,32 after which they slowly fade away during the course of infarct healing with scar formation and resorption of infarct-related myocardial edema and inflammation. 30,33 T 2 -weighted edema imaging can thus be used in differentiating between recent and healed MI.…”

Section: Technical and Clinical Aspects Of Cmr Imaging In Ami Edema Imentioning

confidence: 99%

Correlation of Electrocardiogram and Regional Cardiac Magnetic Resonance Imaging Findings in ST‐Elevation Myocardial Infarction: A Literature Review

Rinta-Kiikka

Tuohinen

Ryymin

et al. 2014

Noninvasive Electrocardiol

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Background:Patients with acute ST-elevation myocardial infarction (STEMI) benefit substantially from emergent coronary reperfusion. The principal mechanism is to open the occluded coronary artery to minimize myocardial injury. Thus the size of the area at risk is a critical determinant of the patient outcome, although other factors, such as reperfusion injury, have major impact on the final infarct size. Acute coronary occlusion almost immediately induces metabolic changes within the myocardium, which can be assessed with both the electrocardiogram (ECG) and cardiac magnetic resonance (CMR) imaging.Methods: The 12-lead ECG is the principal diagnostic method to detect and risk-stratify acute STEMI. However, to achieve a correct diagnosis, it is paramount to compare different ECG parameters with golden standards in imaging, such as CMR. In this review, we discuss aspects of ECG and CMR in the assessment of acute regional ischemic changes in the myocardium using the 17 segment model of the left ventricle presented by American Heart Association (AHA), and their relation to coronary artery anatomy.Results: Using the 17 segment model of AHA, the segments 12 and 16 remain controversial. There is an important overlap in myocardial blood supply at the antero-lateral region between LAD and LCx territories concerning these two segments.Conclusion: No all-encompassing correlation can be found between ECG and CMR findings in acute ischemia with respect to coronary anatomy.

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“…One possible reason for this might be our definition of the standard of reference: LV segments were only rated as affected by AMI if a regional wall motion abnormality and/or an area of LGE in an ischemic pattern was present in an LV segment within the perfusion territory of the culprit vessel. However, it cannot be excluded that myocardial edema is the only sign of ischemic injury at the infarct border [20], which might have disadvantaged T2 mapping due to its higher sensitivity. However, the difference in the observed specificities is small and insignificant from a clinical point of view.…”

Section: Herz 169mentioning

confidence: 99%

“…These limitations include regional myocardial signal variation caused by phased array coils, bright rim artifacts from stagnant blood, and myocardial signal loss caused by through-plane motion [10 -12]. Since several experimental and clinical studies have confirmed the great value of myocardial edema imaging in AMI [7,19,20] as well as in inflammatory cardiomyopathies [9], great efforts have been made to overcome the limitations of T2w darkblood TSE imaging. Within the scope of these efforts, T2w brightblood SSFP sequences have been developed within the last years [13,21,22].…”

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confidence: 99%

Cardiac MRI: T2-Mapping Versus T2-Weighted Dark-Blood TSE Imaging for Myocardial Edema Visualization in Acute Myocardial Infarction

Naßenstein

Nensa

Schlosser

et al. 2013

Fortschr Röntgenstr

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Purpose: To assess the diagnostic accuracy of T2 mapping for the detection of myocardial edema in acute myocardial infarction (AMI), and to compare this diagnostic accuracy with that of the current standard for myocardial edema imaging, which is T2w dark-blood TSE imaging. Materials and Methods: 29 patients with AMI were examined at 1.5?T. For the visualization of myocardial edema, T2 maps, calculated from three T2w SSFP images, and T2w dark-blood TSE images were acquired in standard short- and long-axis views. Cine SSFP images were acquired for the analysis of left ventricular (LV) function and late gadolinium enhancement images (LGE) for the visualization of myocardial necrosis. The T2 maps as well as the T2w dark-blood TSE images were evaluated twice independently from the cine SSFP and LGE images. The presence or absence of myocardial edema was rated visually for each LV segment. As the standard of reference, the infarct zone was defined based on the cine SSFP and the LGE images. Results: In this segment-based analysis, T2 mapping showed a sensitivity of 82?% and a specificity of 94?% for the detection of edema in the infarct zone. T2w dark-blood TSE imaging revealed a sensitivity of 50?% and a specificity of 98?%. T2 mapping showed a higher intra-rater agreement compared to T2w dark-blood TSE imaging (?: 0.87 vs. 0.76). Conclusions: T2 mapping allows for the visualization of myocardial edema in AMI with a high sensitivity and specificity, and features better diagnostic accuracy in terms of a higher sensitivity compared to T2w dark-blood TSE imaging. Citation Format: ??Na?enstein K, Nensa F, Schlosser T et?al. Cardiac MRI: T2-Mapping Versus T2-Weighted Dark-Blood TSE Imaging for Myocardial Edema Visualization in Acute Myocardial Infarction. Fortschr R?ntgenstr 2014; 186: 166???172

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Edema as a Very Early Marker for Acute Myocardial Ischemia

Cited by 202 publications

References 22 publications

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

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

Correlation of Electrocardiogram and Regional Cardiac Magnetic Resonance Imaging Findings in ST‐Elevation Myocardial Infarction: A Literature Review

Cardiac MRI: T2-Mapping Versus T2-Weighted Dark-Blood TSE Imaging for Myocardial Edema Visualization in Acute Myocardial Infarction

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