Gadolinium delayed enhancement cardiovascular magnetic resonance correlates with clinical measures of myocardial infarction

Ingkanisorn, W. Patricia; Rhoads, Kenneth L.; Aletras, Anthony H.; Kellman, Peter; Arai, Andrew E.

doi:10.1016/j.jacc.2004.02.046

Cited by 292 publications

(179 citation statements)

References 26 publications

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“…Our follow-up scans demonstrate that there is some reduction in the size of the acutely determined hyperenhancement area with time, which is supported by recent studies after both myocardial infarction and coronary artery bypass surgery. 18,19 We believe involution of the scar into a smaller volume is the most likely explanation, 20 possibly compounded by partial volume effects of the magnetic resonance technique. A recent study using high-resolution x-ray spectroscopic analysis indicates that gadolinium closely correlates with sodium/potassium concentrations and histologically defined myocardial irreversible injury, which argues against the concept that peri-infarct edema is a possible cause of overestimation of acute infarct size by DE-MRI.…”

Section: Discussionmentioning

confidence: 95%

Troponin Elevation After Percutaneous Coronary Intervention Directly Represents the Extent of Irreversible Myocardial Injury

et al. 2005

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Background-Although troponin elevation after percutaneous coronary intervention (PCI) is common, uncertainties remain about the mechanisms of its release and its relationship to the volume of myocardial tissue loss. Delayedenhancement MRI of the heart has been shown to reliably quantify areas of irreversible myocardial injury. To investigate the quantitative relationship between irreversible injury and cardiac troponin release, we studied the incidence and extent of new irreversible injury in patients undergoing PCI and correlated it to postprocedural changes in cardiac troponin I. Methods and Results-Fifty patients undergoing PCI were studied with preprocedural and postprocedural (24 hours) delayed-enhancement MRI for assessment of new irreversible myocardial injury. Cardiac troponin I measurements were obtained before PCI and 24 hours after PCI. Of these 50 patients, 24 underwent a further third MRI scan at a median of 8 months after the procedure. Mean patient age was 64Ϯ12 years. After the procedure, 14 patients (28%) had evidence of new myocardial hyperenhancement, with a mean mass of 6.0Ϯ5.8 g, or 5.0Ϯ4.8% of total left ventricular mass. All of these patients had raised troponin I levels (range 1.0 to 9.4 g/L). Thirty-four patients (68%) had no elevated troponin I and no evidence of new myocardial necrosis on MRI. There was a strong correlation between the rise in troponin I measurements at 24 hours and mean mass of new myocardial hyperenhancement, both early (rϭ0.84; PϽ0.001) and late (rϭ0.71; PϽ0.001) after PCI, although there was a trend for a reduction in the size of PCI-induced myocardial injury in the late follow-up scan (Pϭ0.07). Conclusions-In the setting of PCI, patients demonstrating postprocedural elevation in troponin I have evidence of new irreversible myocardial injury on delayed-enhancement MRI. The magnitude of this injury correlates directly with the extent of troponin elevation.

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Section: Discussionmentioning

confidence: 95%

Troponin Elevation After Percutaneous Coronary Intervention Directly Represents the Extent of Irreversible Myocardial Injury

et al. 2005

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“…The extent of DCE areas exhibited dramatic regression at follow-up in patients with subepicardial DCE, and to a far lesser degree in the other patients. DCE regression is a constant finding in the healing phase of active myocarditis (20,22,34), whereas only limited decrease is documented in the months following myocardial infarction (35). The "cougar like pattern" of necrotic islands in myocarditis, with scars shrinking and remodeling during healing, as well as the subsequent resolution of edema, are likely to explain the important regression of DCE areas in these patients (22).…”

Section: Discussionmentioning

confidence: 97%

Detection of myocarditis by contrast‐enhanced MRI in patients presenting with acute coronary syndrome but no coronary stenosis

Codreanu

Djaballah

Angioı̈

et al. 2007

Magnetic Resonance Imaging

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Purpose:To prospectively assess the use of cardiac MRI with delayed contrast enhancement (DCE) for identifying patients with active myocarditis among those presenting with acute coronary syndrome (ACS) but no coronary stenosis. Materials and Methods:A total of 27 consecutive patients (age ϭ 45 Ϯ 17 years; 14 male) presenting with ACS (chest pain, positive troponin-I) and no coronary stenosis, underwent cardiac MRI 9 Ϯ 7 days after pain onset and 8 Ϯ 5 months later (N ϭ 19). Steady-state free-precession pulse (SSFP) sequence was applied for the assessment of myocardial function and both inversion-recovery (IR) and SSFP sequences were used for analyzing the topography and extent of DCE areas. Rest sestamibi-gated-single photon emission CT (SPECT) was also systematically performed.Results: Subepicardial DCE pattern typical of acute myocarditis was documented in 12 patients (44%). Ischemic DCE pattern (transmural or subendocardial focal DCE) was documented in 12 of the 15 remaining patients (44%). Patients with subepicardial DCE had: higher C-reactive protein (CRP) levels (38 Ϯ 32 vs. 14 Ϯ 24 mg/mL; P ϭ 0.04), lower Framingham cardiovascular risk (3 Ϯ 3% vs. 9 Ϯ 5%; P Ͻ 0.001), lower incidence of perfusion SPECT defects (17% vs. 73%; P ϭ 0.01), higher left ventricular (LV) enddiastolic volume (77 Ϯ 16 vs. 64 Ϯ 10 mL/m 2 ; P ϭ 0.02), and higher regression of DCE areas at follow-up (-65 Ϯ 17% vs. -18 Ϯ 23%; P ϭ 0.002).Conclusion: DCE pattern of active myocarditis can be seen in patients presenting with ACS but no coronary stenosis.

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“…This increase in contrast agent shortens the T1 of the tissue, making regions of scar tissue visible when an inversion recovery sequence set to null the normal myocardium is used (1). DE MRI has become the gold standard for noninvasively identifying the presence and extent of myocardial scarring (2)(3)(4). DE MRI can also discriminate small regions of sub-endocardial infarct from viable tissue and has shown promise for reproducible sizing of infarcts and viability assessment in serial studies (5,6).…”

Section: Introductionmentioning

confidence: 99%

Quantitative myocardial distribution volume from dynamic contrast-enhanced MRI

Pack

DiBella

Wilson

et al. 2008

Magnetic Resonance Imaging

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The objective of this study was to investigate if dynamic contrast-enhanced magnetic resonance imaging (MRI) can be used to quantitate the distribution volume (v e ) in regions of normal and infarcted myocardium. v e reflects the volume of the extra-cellular, extra-vascular space within the myocardial tissue. In regions of the heart where an infarct has occurred, the loss of viable cardiac cells results in an elevated v e compared to normal regions. A quantitative estimate of the magnitude and spatial distribution of v e is significant because it may provide information complementary to delayed enhancement MRI alone.Using a hybrid gradient echo-echo planar imaging (GRE-EPI) pulse sequence on a 1.5T MRI scanner, 12 normal subjects and four infarct patients were imaged dynamically, during the injection of a contrast agent, to measure the regional blood and tissue enhancement in the left ventricular (LV) myocardium. Seven of the normal subjects and all of the infarct patients were also imaged at steadystate contrast enhancement to estimate the steady-state ratio of contrast agent in the tissue and blood (Ct/Cb)-a validated measure of v e . Normal and infarct regions of the LV were manually selected and the blood and tissue enhancement curves were fit to a compartment model to estimate v e . Also, the effect of the vascular blood signal on estimates of v e was evaluated using simulations and in the dynamic and steady-state studies.Aggregate estimates of v e were 23.6% ± 6.3% in normal myocardium and 45.7% ± 3.4% in regions of infarct. These results were not significantly different from the reference standards of Ct/Cb (22.9% ± 6.8% and 42.6% ± 6.3%, p=0.073). From the dynamic contrast-enhanced studies, approximately one minute of scan time was necessary to estimate v e in the normal myocardium to within 10% of the steady-state estimate. In regions of infarct, up to three minutes of dynamic data was required to estimate v e to within 10% of the steady-state v e value.By measuring the kinetics of blood and tissue enhancement in the myocardium during an extended dynamic contrast enhanced MRI study, v e may be estimated using compartment modeling.

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Gadolinium delayed enhancement cardiovascular magnetic resonance correlates with clinical measures of myocardial infarction

Abstract: In humans imaged shortly after acute MI, gadolinium delayed enhancement acute CMR infarct size correlates with acute and chronic indices of infarct size but will appear to diminish in size on follow-up.

Cited by 292 publications

References 26 publications

Troponin Elevation After Percutaneous Coronary Intervention Directly Represents the Extent of Irreversible Myocardial Injury

Troponin Elevation After Percutaneous Coronary Intervention Directly Represents the Extent of Irreversible Myocardial Injury

Detection of myocarditis by contrast‐enhanced MRI in patients presenting with acute coronary syndrome but no coronary stenosis

Quantitative myocardial distribution volume from dynamic contrast-enhanced MRI

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