Peri-Infarct Ischemia Determined by Cardiovascular Magnetic Resonance Evaluation of Myocardial Viability and Stress Perfusion Predicts Future Cardiovascular Events in Patients with Severe Ischemic Cardiomyopathy

Tsukiji, Miwako; Nguyen, Patricia K.; Narayan, Girish; Hellinger, Jeffrey C.; Chan, Frandics P.; Herfkens, Robert J.; Pauly, John M.; McConnell, Michael V.; Yang, Phillip C.

doi:10.1080/10976640600737615

Cited by 28 publications

(15 citation statements)

References 24 publications

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“…Several studies have confirmed the association of the peri-infarct region with ventricular arrhythmias and remodeling, which was reduced significantly with revascularization of the injured region [17–19,20–22]. Thus, a precise characterization of cell viability and injury in this vulnerable region is imperative.…”

Section: Discussionmentioning

confidence: 99%

Apelin-13 infusion salvages the peri-infarct region to preserve cardiac function after severe myocardial injury

Chung

Cho

Byun

et al. 2016

International Journal of Cardiology

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Background Apelin-13 (A13) regulates cardiac homeostasis. However, the effects and mechanism of A13 infusion after an acute myocardial injury (AMI) have not been elucidated. This study assesses the restorative effects and mechanism of A13 on the peri-infarct region in murine AMI model. Methods 51 FVB/N mice (12 weeks, 30 g) underwent AMI. A week following injury, continuous micro-pump infusion of A13 (0.5 μg/g/day) and saline was initiated for 4-week duration. Dual contrast MRI was conducted on weeks 1, 2, 3, and 5, consisting of delayed-enhanced and manganese-enhanced MRI. Four mice in each group were followed for an extended period of 4 weeks without further infusion and underwent MRI scans on weeks 7 and 9. Results A13 infusion demonstrated preserved LVEF compared to saline from weeks 1 to 4 (21.9 ± 3.2% to 23.1 ± 1.7%* vs. 23.5 ± 1.7% to 16.9 ± 2.8%, *p = 0.02), which persisted up to 9 weeks post-MI (+1.4%* vs. −9.4%, *p = 0.03). Mechanistically, dual contrast MRI demonstrated significant decrease in the peri-infarct and scar % volume in A13 group from weeks 1 to 4 (15.1 to 7.4% and 34.3 to 25.1%, p = 0.02, respectively). This was corroborated by significant increase in 5-ethynyl-2′-deoxyuridine (EdU+) cells by A13 vs. saline groups in the peri-infarct region (16.5 ± 3.1% vs. 8.1 ± 1.6%; p = 0.04), suggesting active cell mitosis. Finally, significantly enhanced mobilization of CD34+ cells in the peripheral blood and up-regulation of APJ, fibrotic, and apoptotic genes in the peri-infarct region were found. Conclusions A13 preserves cardiac performance by salvaging the peri-infarct region and may contribute to permanent restoration of the severely injured myocardium.

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Section: Discussionmentioning

confidence: 99%

Apelin-13 infusion salvages the peri-infarct region to preserve cardiac function after severe myocardial injury

Chung

Cho

Byun

et al. 2016

International Journal of Cardiology

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“…Recent studies indicate that injured but viable myocytes in the peri-infarct territory consistent with nontransmural infarction might lead to CVE (14,26). The presence of residual viable myocardium, as a path of conduction and/or site of peri-infarct ischemia, might be a necessary cofactor in the pathogenesis of CVE, a conclusion that has Clinical and CMR Characteristics of Patients been reported in previous studies (14,26). This study demonstrated that a more quantitative evaluation of the nontransmural extent of MI through analyzing the size of the border zone (peri-infarct injury zone) demonstrates a higher association with CVE in this patient population of high morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

Quantitative Tissue Characterization of Infarct Core and Border Zone in Patients With Ischemic Cardiomyopathy by Magnetic Resonance Is Associated With Future Cardiovascular Events

Heidary

Patel

Chung

et al. 2010

Journal of the American College of Cardiology

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109

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“…The definition of peri-infarct ischaemia using CMR may be debatable. However, all previous studies 7,8 have used the same criteria. The extent of the inducible perfusion defect under adenosine stress was compared in the corresponding delayed-enhanced images to see whether the perfusion defect overlaps the extent of the infarcted myocardial tissue or not.…”

Section: Discussionmentioning

confidence: 99%

“…5 Furthermore, myocardial perfusion can be reliably assessed with CMR at both rest and stress. 6 Only a few studies 7,8 have evaluated CMR in the detection of peri-infarction ischaemia. However, no method is currently available to quantify the extent of peri-infarction ischaemia using CMR.…”

Section: Advances In Knowledgementioning

confidence: 99%

Peri-infarct ischaemia assessed by cardiovascular MRI: comparison with quantitative perfusion single photon emission CT imaging

Gerbaud

Cochet²,

Bullier³

et al. 2014

BJR

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Objective: To develop a new method for the cardiac MR (CMR) quantification of peri-infarct ischaemia using fused perfusion and delayed-enhanced images and to evaluate this method using quantitative single photon emission CT (SPECT) imaging as a reference. Methods: 40 patients presenting with peri-infarct ischaemia on a routine stress 99m Tc-SPECT imaging were recruited. Within 8 days of the SPECT study, myocardial perfusion was evaluated using stress adenosine CMR. Using fused perfusion and delayed-enhanced images, peri-infarct ischaemia was quantified as the percentage of myocardium with stress-induced perfusion defect that was adjacent to and larger than a scar. This parameter was compared with both the percent myocardium ischaemia (SD%) and the ischaemic total perfusion deficit (TPD). The diagnostic performance of CMR in detection of significant coronary artery stenosis (of $70%) was also determined. Results: On SPECT imaging, in addition to peri-infarct ischaemia, reversible perfusion abnormalities were detected in a remote zone in seven patients. In the 33 patients presenting with only peri-infarct ischaemia, the agreement between CMR peri-infarct ischaemia and both SD% and ischaemic TPD was excellent [intraclass coefficient of correlation (ICC) 5 0.969 and ICC 5 0.877, respectively]. CMR-defined peri-infarct ischaemia for the detection of a significant coronary artery stenosis showed an areas under receiver-operating characteristic curve of 0.856 (95% confidence interval, 0.680-0.939). The best cut-off value was 8.1% and allowed a 72% sensitivity, 96% specificity, 60% negative predictive value and 97% positive predictive value.Conclusion: This proof-of-concept study shows that CMR imaging has the potential as a test for quantification of peri-infarct ischaemia. Advances in knowledge:This study demonstrates the proof of concept of a commonly known intuitive idea, that is, evaluating the peri-infarct ischaemic burden by subtracting delayed enhancement from first-pass perfusion imaging on CMR.Stress 99m Tc myocardial perfusion imaging is a clinically useful tool for assessment of ischaemia, particularly including peri-infarction ischaemia.1 Peri-infarction ischaemia detected on quantitative perfusion single photon emission CT (SPECT) imaging is associated with restenosis 6 months after acute myocardial infarction (AMI).2 Periinfarction ischaemia is also associated with a greater risk of cardiac death than remote ischaemia.3 In addition, periinfarction ischaemia is a trigger of ventricular arrhythmias. 4 The assessment of segmental viability after AMI is possible using cardiac MR (CMR) imaging of contractile reserve, microvascular obstruction and delayed enhancement extent. Furthermore, myocardial perfusion can be reliably assessed with CMR at both rest and stress.6 Only a few studies 7,8 have evaluated CMR in the detection of peri-infarction ischaemia. However, no method is currently available to quantify the extent of peri-infarction ischaemia using CMR. Therefore, the main objective of this study was to dev...

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Peri-Infarct Ischemia Determined by Cardiovascular Magnetic Resonance Evaluation of Myocardial Viability and Stress Perfusion Predicts Future Cardiovascular Events in Patients with Severe Ischemic Cardiomyopathy

Cited by 28 publications

References 24 publications

Apelin-13 infusion salvages the peri-infarct region to preserve cardiac function after severe myocardial injury

Apelin-13 infusion salvages the peri-infarct region to preserve cardiac function after severe myocardial injury

Quantitative Tissue Characterization of Infarct Core and Border Zone in Patients With Ischemic Cardiomyopathy by Magnetic Resonance Is Associated With Future Cardiovascular Events

Peri-infarct ischaemia assessed by cardiovascular MRI: comparison with quantitative perfusion single photon emission CT imaging

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