Extracellular volume imaging by magnetic resonance imaging provides insights into overt and sub-clinical myocardial pathology

Ugander, Martin; Oki, Abiola J; Hsu, Li Yueh; Kellman, Peter; Greiser, Andreas; Aletras, Anthony H.; Sibley, Christopher T.; Chen, Marcus Y; Bandettini, W. Patricia; Arai, Andrew E.

doi:10.1093/eurheartj/ehr481

Cited by 496 publications

(444 citation statements)

References 34 publications

(43 reference statements)

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“…Although native T1 mapping14 and postcontrast T1 mapping13 CMR have been used to interrogate remote myocardial ECM, the availability of automated extracellular volume fraction (ECV) mapping CMR provides a more robust method for quantifying not only focal fibrosis, but also diffuse interstitial expansion in the myocardium15, 16 given that native and postcontrast T1 maps are coregistered and motion corrected, thereby improving the quality of the generated automated maps 17…”

Section: Introductionmentioning

confidence: 99%

Automated Extracellular Volume Fraction Mapping Provides Insights Into the Pathophysiology of Left Ventricular Remodeling Post–Reperfused ST‐Elevation Myocardial Infarction

Bulluck

Rosmini

Abdel‐Gadir

et al. 2016

JAHA

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BackgroundWhether the remote myocardium of reperfused ST‐segment elevation myocardial infarction (STEMI) patients plays a part in adverse left ventricular (LV) remodeling remains unclear. We aimed to use automated extracellular volume fraction (ECV) mapping to investigate whether changes in the ECV of the remote (ECVR emote) and infarcted myocardium (ECVI nfarct) impacted LV remodeling.Methods and ResultsForty‐eight of 50 prospectively recruited reperfused STEMI patients completed a cardiovascular magnetic resonance at 4±2 days and 40 had a follow‐up scan at 5±2 months. Twenty healthy volunteers served as controls. Mean segmental values for native T1, T2, and ECV were obtained. Adverse LV remodeling was defined as ≥20% increase in LV end‐diastolic volume. ECVR emote was higher on the acute scan when compared to control (27.9±2.1% vs 26.4±2.1%; P=0.01). Eight patients developed adverse LV remodeling and had higher ECVR emote acutely (29.5±1.4% vs 27.4±2.0%; P=0.01) and remained higher at follow‐up (28.6±1.5% vs 26.6±2.1%; P=0.02) compared to those without. Patients with a higher ECVR emote and a lower myocardial salvage index (MSI) acutely were significantly associated with adverse LV remodeling, independent of T1Remote, T1Core and microvascular obstruction, whereas a higher ECVI nfarct was significantly associated with worse wall motion recovery.Conclusions ECVR emote was increased acutely in reperfused STEMI patients. Those with adverse LV remodeling had higher ECVR emote acutely, and this remained higher at follow‐up than those without adverse LV remodeling. A higher ECVR emote and a lower MSI acutely were significantly associated with adverse LV remodeling whereas segments with higher ECVI nfarct were less likely to recover wall motion.

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Section: Introductionmentioning

confidence: 99%

Automated Extracellular Volume Fraction Mapping Provides Insights Into the Pathophysiology of Left Ventricular Remodeling Post–Reperfused ST‐Elevation Myocardial Infarction

Bulluck

Rosmini

Abdel‐Gadir

et al. 2016

JAHA

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“…45 There are several studies that showed that T1-mapping is useful in identifying more diffuse forms of fibrosis in the remote myocardium and the peri-infarct area (the acquisition time is faster and the spatial resolution is better). 46,47 The notion of peri-infarct zone ("gray zone") was introduced by Schmidt et al The quantification of the peri-infarcted zone can be made by tracing the endo-and epicardial margins in the short-axis sequence and the hypersignal region. 41 The infarct nucleus is defined as the region from the myocardium with a signal intensity higher than 50%.…”

Section: Assessment Of Myocardial Viabilitymentioning

confidence: 99%

Cardiac Magnetic Resonance and Myocardial Viability: Why Is It so Important?

Rodean¹,

Beganu²,

Hodaş³

et al. 2017

Journal of Interdisciplinary Medicine

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For a better assessment of ischemic heart diseases, myocardial viability should be quantified. Current studies underline the importance and the evolution of several techniques and methods used in the evaluation of myocardial viability. Taking into account these considerations, the aim of this manuscript was to present the recent points of view regarding myocardial viability and its clinical significance in patients with ischemic cardiomyopathies and left ventricular dysfunction. On the other hand, the manuscript points out the role of magnetic resonance imaging (MRI), one of the most useful noninvasive imaging techniques, in the assessment of myocardial viability. By comparing the advantages and disadvantages of cardiac MRI, its usefulness can be better appreciated by the clinician. In the following years, it is considered that MRI will be an indispensable imaging tool in the assessment of ischemic heart disease, guiding interventions for revascularization and long-term risk stratification in patients with stable angina or myocardial infarction.

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“…51 This is true especially with the changes resulting from pathologies other than MI, where the differences between the normal and affected myocardium are less distinct. 47,[51][52][53] Therefore, the more widespread clinical use of these tissue characterization techniques requires further exploration.…”

Section: Myocardial T1 Mapping and Extracellular Volume (Ecv) Fractionmentioning

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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Extracellular volume imaging by magnetic resonance imaging provides insights into overt and sub-clinical myocardial pathology

Cited by 496 publications

References 34 publications

Automated Extracellular Volume Fraction Mapping Provides Insights Into the Pathophysiology of Left Ventricular Remodeling Post–Reperfused ST‐Elevation Myocardial Infarction

Automated Extracellular Volume Fraction Mapping Provides Insights Into the Pathophysiology of Left Ventricular Remodeling Post–Reperfused ST‐Elevation Myocardial Infarction

Cardiac Magnetic Resonance and Myocardial Viability: Why Is It so Important?

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

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