Infarct resorption, compensatory hypertrophy, and differing patterns of ventricular remodeling following myocardial infarctions of varying size

Fieno, David S.; Hillenbrand, Hanns B.; Rehwald, Wolfgang G; Harris, Kathleen R.; Decker, Robert S.; Parker, Michele; Klocke, Francis J.; Kim, Raymond J.; Judd, Robert M.

doi:10.1016/j.jacc.2004.01.043

Cited by 146 publications

(93 citation statements)

References 18 publications

(23 reference statements)

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“…This is possible because DE-MRI can assess serially, concurrent directionally opposite changes such as resorption of infarcted tissue and hypertrophy of viable myocardium. 51 When only viable myocardium can be visualized, the percentage of viability in a given segment is assessed indirectly and generally refers to the amount of viability in the segment normalized to the segment with the maximum amount of viability or to data from a gender-specific database of controls. Conversely, when both viable and infarcted myocardium can be visualized, the percentage of viability can be assessed directly and expressed as the amount of viability in the segment normalized to the amount of viability plus infarction in the same segment (Figure 10a).…”

Section: Infarction and Viabilitymentioning

confidence: 99%

Frontiers in Cardiovascular Magnetic Resonance

Fuster

Kim

2005

Circulation

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Section: Infarction and Viabilitymentioning

confidence: 99%

Frontiers in Cardiovascular Magnetic Resonance

Fuster

Kim

2005

Circulation

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“…9) Following the myocardial edema, approximately 40 minutes after coronary occlusion, the extent of endocardial infarction is established and remains equal up to 8 weeks. 8,17) When the endocardial extent is established, the infarction will progress from the endocardium to the epicardium as the duration of ischemia increases. This is often referred to as the wavefront phenomenon.…”

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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“…The same imaging parameters as above were used except with a TI of 250 -325 msec (adjusted to null viable myocardium) and a TR of two cardiac cycles (1100 -1600 msec). Both image acquisition and data analysis were carried out by scrupulously adhering to DE methods as described in recent literature (23) and practiced in the clinic, so that the results would not be biased by our hypotheses.…”

Section: Pca Preparation and Administrationmentioning

confidence: 99%

“…Thus, the delayed contrast enhancement (DE) method of ceMRI is now widely accepted for the determination of infarct size (8,11,13,15,18 -22). Enhancement is defined by most investigators as a signal intensity (SI) increased by at least 2 SDs above that of normal myocardium (13,23). Unfortunately, however, there is no unanimity among investigators, as some groups use 6 SDs, and others use a "user-specified threshold" (16 -18,24).…”

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Head‐to‐head comparison between delayed enhancement and percent infarct mapping for assessment of myocardial infarct size in a canine model

Ruzsics

Surányi

Kiss

et al. 2008

Magnetic Resonance Imaging

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Purpose: To compare a novel method, percent-infarctmapping (PIM), with conventional delayed enhancement (DE) of contrast for accurate myocardial viability assessment. Contrary to signal intensity (SI), the longitudinal relaxation-rate enhancement (⌬R1) is an intrinsic parameter linearly proportional to the concentration of contrast agent (CA). Determining ⌬R1 voxel-by-voxel, after administering an infarct-avid CA, allows determination of pervoxel percentage of infarcted tissue. The feasibility of generating PIM is demonstrated in canine reperfused infarction using an infarct-avid, persistent-CA (PCA), (Gd)(ABE-DTTA). PIM is compared to the DE method using Gd(DTPA), and both to triphenyltetrazolium chloride (TTC) staining histochemistry. Materials and Methods:In six dogs, 48 hours following closed-chest, 180-minute coronary occlusion, DE imaging was carried out. PCA was administered immediately thereafter. Pixel-by-pixel R1 maps of the entire left ventricle (LV) were generated 48 hours after PCA using inversion-recovery with multiple inversion times. R1, ⌬R1, and percentinfarct values were calculated voxel-by-voxel.Results: Significant correlations (P Ͻ 0.01, R Ն 0.8) were obtained for percent-infarct-per-slice (PIS) determined by DE or PIM vs. those from corresponding TTC-stained slices. Compared to TTC, DE overestimated PIS by 32 Ϯ 18%. PIM underestimated PIS by 2.5 Ϯ 4.9%. Infarction fraction overestimation was 29 Ϯ 6% of LV by DE, but only 1.0 Ϯ 2.3% by PIM. Errors with PIM were significantly smaller than those with DE. Infarct area determined by signal intensity was similarly overestimated whether using Gd(DTPA) or Gd(ABE-DTTA). Conclusion:The ⌬R1-based PIM method is highly reproducible and more accurate than DE for quantifying myocardial viability in vivo.

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Infarct resorption, compensatory hypertrophy, and differing patterns of ventricular remodeling following myocardial infarctions of varying size

Abstract: Concurrent directionally opposite changes in infarcted and noninfarcted myocardium can be defined serially, noninvasively, and with high spatial resolution and full ventricular coverage following myocardial infarction.

Cited by 146 publications

References 18 publications

Frontiers in Cardiovascular Magnetic Resonance

Frontiers in Cardiovascular Magnetic Resonance

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

Head‐to‐head comparison between delayed enhancement and percent infarct mapping for assessment of myocardial infarct size in a canine model

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