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

Abstract

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)

Accuracy of Late Gadolinium Enhancement - Magnetic Resonance Imaging in the Measurement of Left Atrial Substrate Remodeling in Patients With Rheumatic Mitral Valve Disease and Persistent Atrial Fibrillation -

“…[9][10][11][12] However, due to limitations in spatial resolution, the imaging of the thinner atrial wall is more challenging. Recent advancements in MRI techniques have provided higher-resolution images that enable the localization and quantification of atrial SRM.…”

“…8,9) The utility of LGE-MRI to characterize ventricular myocardial injury has been confirmed using comprehensive pathological validation studies, and the method is now widely used in clinical practice. [9][10][11][12] Several recent pilot studies that involved electrical and/or pathological validation have reported that cardiac MRI is useful for characterizing transcatheter ablation-induced atrial scar tissue in animal models. 8,13) However, no fundamental pathological validation study has been conducted on the use of cardiac LGE-MRI for the assessment of pre-ablation LA-SRM in AF patients.…”

Relationship between Framingham Risk Score and Left Ventricular Remodeling after Successful Primary Percutaneous Coronary Intervention in Patients with First Myocardial Infarction and Single Vessel Disease

“…Wall motion was assigned the following scores: normal wall motion was 0, mild hypokinesia 1, severe hypokinesia 2, akinesia 3, and dyskinesia 4. The wall motion score index was calculated by dividing the sum of scores in each segment by the total number of observed segments [9].…”

“…In addition, chronic medical therapy has been shown to reduce the extent of LV remodeling during follow-up [4][5][6]. Both LV remodeling and infarct tissue characteristics can be assessed with cardiovascular magnetic resonance (CMR) imaging in combination with the contrast enhancement (CE) technique [7][8][9][10]. There is no such thing as a "single cause" of LV remodeling, which can even be observed following successful revascularization procedures.…”

Native Myocardial T1 Mapping, Are We There Yet?

“…Some clinical examples for this role are the assessment of ischemic cardiac disease, non-ischemic cardiomyopathy, myocarditis, and infiltrative heart diseases. [3][4][5][6][7] However, the myocardial involvement in these different pathologies is sometimes diffuse and can, on the other hand, have myocardial fibrosis as its final product. Both myocardial fibrosis and diffuse myocardial disease pose some challenges to conventional CMR sequences where fibrosis is exclusively detected by late gadolinium enhancement (LGE) MRI that again may miss a diffuse or early disease and is contraindicated in renal dysfunction.…”