Peri-infarct dysfunction in post-myocardial infarction: assessment of 3-T tagged and late enhancement MRI

Inoue, Yuichi; Yang, Xiaomei; Nagao, Michinobu; Hara, Hiroshi; Hosokawa, Kohei; Kido, Teruhiko; Kurata, Akira; Okayama, Hideki; Higaki, Jitsuo; Mochizuki, Takashi; Murase, Kenya

doi:10.1007/s00330-009-1657-2

Cited by 25 publications

(31 citation statements)

References 35 publications

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“…angiotensin converting enzyme inhibitors, beta-blockers), and definitely less pronounced than what was observed in older studies [12,13,24]. Contrary to previous work we could not demonstrate remote myocardial hypertrophy, or increased remote myocardial contractility to compensate for the loss of function in the infarcted myocardium [25][26][27]. Instead, myocardial mass significantly decreased early after acute MI, and to remain unchanged at longer follow-up.…”

Section: Discussioncontrasting

confidence: 86%

“…Additionally, the presence of MVO, maximum troponin I levels as well as LV mass at baseline independently predicted adverse LV remodelling at 4M and 1Y with decreasing power (Tables 5 and 6). When comparing patients with and without adverse LV remodelling (Table 7), we found that at baseline those with adverse LV remodelling had a larger infarct size (15.2± 9.1 g vs. 27.4±17.8, p=0.01). The LVEDV and LVESV indices at baseline were not different between patients who subsequently developed adverse LV remodelling and those who did not.…”

Section: Predictive Factors Of Adverse LV Remodellingmentioning

confidence: 84%

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Time course of infarct healing and left ventricular remodelling in patients with reperfused ST segment elevation myocardial infarction using comprehensive magnetic resonance imaging

et al. 2010

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Infarct healing, with shrinkage of infarcted myocardium and wall thinning, occurs early post-MI as reflected by loss in LV mass and adjacent myocardial remodelling. Longer follow-up demonstrates ongoing remote myocardial and ventricular remodelling. Infarct size at baseline predicts long-term LV remodelling and represents an important parameter for tailoring future post-MI pharmacological therapies designed to prevent heart failure.

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Section: Discussioncontrasting

confidence: 86%

Section: Predictive Factors Of Adverse LV Remodellingmentioning

confidence: 84%

Time course of infarct healing and left ventricular remodelling in patients with reperfused ST segment elevation myocardial infarction using comprehensive magnetic resonance imaging

et al. 2010

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“…[27][28][29] Our findings suggest that CE-CMR examination of the heterogeneity of the infarct zone may provide valuable insights into the process of LV remodeling.…”

Section: Discussionmentioning

confidence: 80%

“…There is increasing interest in quantification of this peri-infarct zone because (mechanical) characteristics of this area may serve as a substrate for lifethreatening ventricular arrhythmia. 9,21,22,27) According to Yan, et al identification of a distinct infarct core and border zone may also provide prognostic insights into post-MI remodeling. 9) However, most previous CE-CMR studies that investigated the relationship between infarct size and cardiac remodeling did not measure the size of the peri-infarct zone.…”

Section: Discussionmentioning

confidence: 99%

Relationship Between Infarct Tissue Characteristics and Left Ventricular Remodeling in Patients With Versus Without Early Revascularization for Acute Myocardial Infarction as Assessed With Contrast-Enhanced Cardiovascular Magnetic Resonance Imaging

et al. 2012

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SummaryLeft ventricular (LV) remodeling following myocardial infarction (MI) is the result of complex interactions between various factors, including presence or absence of early revascularization. The impact of early revascularization on the relationship between infarct tissue characteristics and LV remodeling is incompletely known. Therefore, we investigated in patients with versus without successful early revascularization for acute MI potential relations between infarct tissue characteristics and LV remodeling with contrast-enhanced (CE) cardiovascular magnetic resonance (CMR). Patients with versus without successful early revascularization underwent CE-CMR for tissue characterization and assessment of LV remodeling including end-diastolic and end-systolic volumes, LV ejection fraction, and wall motion score index (WMSI). CE-CMR images were analyzed for infarct tissue characteristics including core-, peri-and total-infarct size, transmural extent, and regional scar scores. In early revascularized patients (n = 46), a larger area of infarct tissue correlated significantly with larger LV dimensions and a more reduced LV function (r = 0.39-0.68; all P ≤ 0.01). Multivariate analyses identified peri-infarct size as the best predictor of LV remodeling parameters (R 2 = 0.44-0.62). In patients without successful early revascularization (n = 47), there was no correlation between infarct area and remodeling parameters; only peri-infarct size versus WMSI (r = 0.33; P = 0.03) and transmural extent versus LVEF (r = -0.27; P = 0.07) tended to be related. A correlation between infarct tissue characteristics and LV remodeling was found only in patients with early successful revascularization. Peri-infarct size was found to be the best determinant of LV remodeling. Our findings stress the importance of taking into account infarct tissue characteristics and success of revascularization when LV remodeling is studied. (Int Heart J 2012; 53: 263-269)

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“…Although previously investigated in the chronic ischaemic cardiomyopathy setting [5,6], systematic data following acute ST-segment elevation myocardial infarction (STEMI) is lacking. CMR imaging offers the capability of unparalleled evaluation of ventricular size and function, quantification of infarct size and the degree of microvascular obstruction (MVO).…”

Section: Introductionmentioning

confidence: 99%

Electro-mechanical characteristics of myocardial infarction border zones and ventricular arrhythmic risk: novel insights from grid-tagged cardiac magnetic resonance imaging

et al. 2012

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Objective To investigate whether grid-tag myocardial strain evaluation can characterise 'border-zone' peri-infarct region and identify patients at risk of ventricular arrhythmia as the peri-infarct myocardial zone may represent an important contributor to ventricular arrhythmia following ST-segment elevation myocardial infarction (STEMI). Methods Forty-five patients with STEMI underwent cardiac magnetic resonance (CMR) imaging on days 3 and 90 following primary percutaneous coronary intervention (PCI). Circumferential peak circumferential systolic strain (CS) and strain rate (CSR) were calculated from grid-tagged images. Myocardial segments were classified into 'infarct', 'borderzone', 'adjacent' and 'remote' regions by late-gadolinium enhancement distribution. The relationship between CS and CSR and these distinct myocardial regions was assessed. Ambulatory Holter monitoring was performed 14 days post myocardial infarction (MI) to estimate ventricular arrhythmia risk via evaluation of heart-rate variability (HRV). ResultsWe analysed 1,222 myocardial segments. Remote and adjacent regions had near-normal parameters of CS and CSR. Border-zone regions had intermediate CS (-9.0±4.6 vs -5.9± 7.4, P<0.001) and CSR (-86.4±33.3 vs -73.5±51.4, P<0.001) severity compared with infarct regions. Patients with 'borderzone' peri-infarct regions had reduced very-low-frequency power on HRV analysis, which is a surrogate for ventricular arrhythmia risk (P00.03). Conclusion Grid-tagged CMR-derived myocardial strain accurately characterises the mechanical characteristics of 'border-zone' peri-infarct region. Presence of 'border-zone' peri-infarct region correlated with a surrogate marker of heightened arrhythmia risk following STEMI. Key Points • Grid-tagged cardiac magnetic resonance (CMR) offers new insights into myocardial mechanical function. • Grid-tagged CMR identified different characteristics in 'border-zone' and 'adjacent' peri-infarct myocardial regions. • Reduced very-low-frequency (VLF) power is associated with arrhythmic and mortality risk. • The presence of 'border-zone' peri-infarct region correlated with reduced VLF power.

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Peri-infarct dysfunction in post-myocardial infarction: assessment of 3-T tagged and late enhancement MRI

Abstract: Contractile dysfunction demonstrated by peak strain was correlated with location at different distances from the infarct. In the border zone, contractile deformation was characterised as earlier T-RS, T-CS and T-ES and greater P-CS than in the infarct area.

Cited by 25 publications

References 35 publications

Time course of infarct healing and left ventricular remodelling in patients with reperfused ST segment elevation myocardial infarction using comprehensive magnetic resonance imaging

Time course of infarct healing and left ventricular remodelling in patients with reperfused ST segment elevation myocardial infarction using comprehensive magnetic resonance imaging

Relationship Between Infarct Tissue Characteristics and Left Ventricular Remodeling in Patients With Versus Without Early Revascularization for Acute Myocardial Infarction as Assessed With Contrast-Enhanced Cardiovascular Magnetic Resonance Imaging

Electro-mechanical characteristics of myocardial infarction border zones and ventricular arrhythmic risk: novel insights from grid-tagged cardiac magnetic resonance imaging

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