Relationship of MRI Delayed Contrast Enhancement to Irreversible Injury, Infarct Age, and Contractile Function

Kim, Raymond J.; Fieno, David S.; Parrish, Todd B.; Harris, Kathleen R.; Chen, Enn Ling; Simonetti, Orlando P.; Bundy, Jeffrey M.; Finn, J. Paul; Klocke, Francis J.; Judd, Robert M.

doi:10.1161/01.cir.100.19.1992

Cited by 2,292 publications

(1,709 citation statements)

References 35 publications

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“…Tissues with weak intracellular bonds and high amounts of non-cellular space, including necrotic tissue or fibrous scar, will develop higher concentrations of gadolinium than the surrounding healthy tissues. Scar detected by LGE-CMR has been shown to closely match histologically proven myocardial infarction [57]. …”

Section: Tissue Characterizationmentioning

confidence: 99%

Optimal site selection and image fusion guidance technology to facilitate cardiac resynchronization therapy

Sieniewicz

Gould

Porter

et al. 2018

Expert Review of Medical Devices

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Introduction: Cardiac resynchronization therapy (CRT) has emerged as one of the few effective treatments for heart failure. However, up to 50% of patients derive no benefit. Suboptimal left ventricle (LV) lead position is a potential cause of poor outcomes while targeted lead deployment has been associated with enhanced response rates. Image-fusion guidance systems represent a novel approach to CRT delivery, allowing physicians to both accurately track and target a specific location during LV lead deployment.Areas covered: This review will provide a comprehensive evaluation of how to define the optimal pacing site. We will evaluate the evidence for delivering targeted LV stimulation at sites displaying favorable viability or advantageous mechanical or electrical properties. Finally, we will evaluate several emerging image-fusion guidance systems which aim to facilitate optimal site selection during CRT.Expert commentary: Targeted LV lead deployment is associated with reductions in morbidity and mortality. Assessment of tissue characterization and electrical latency are critical and can be achieved in a number of ways. Ultimately, the constraints of coronary sinus anatomy have forced the exploration of novel means of delivering CRT including endocardial pacing which hold promise for the future of CRT delivery.

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Section: Tissue Characterizationmentioning

confidence: 99%

Optimal site selection and image fusion guidance technology to facilitate cardiac resynchronization therapy

Sieniewicz

Gould

Porter

et al. 2018

Expert Review of Medical Devices

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“…Cardiovascular magnetic resonance (CMR) provides an accurate method for in vivo assessment of infarct size,14, 15 area at risk,16, 17, 18, 19 myocardial salvage index,20, 21 MVO,22 LV mass, and LV ejection fraction (LVEF) 23…”

Section: Introductionmentioning

confidence: 99%

Left Ventricular Hypertrophy Is Associated With Increased Infarct Size and Decreased Myocardial Salvage in Patients With ST‐Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Nepper‐Christensen

Lønborg

Ahtarovski

et al. 2017

JAHA

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BackgroundApproximately one third of patients with ST‐segment elevation myocardial infarction (STEMI) have left ventricular hypertrophy (LVH), which is associated with impaired outcome. However, the causal association between LVH and outcome in STEMI is unknown. We evaluated the association between LVH and: myocardial infarct size, area at risk, myocardial salvage, microvascular obstruction, left ventricular (LV) function (all determined by cardiac magnetic resonance [CMR]), and all‐cause mortality and readmission for heart failure in STEMI patients treated with primary percutaneous coronary intervention.Methods and ResultsIn this substudy of the DANAMI‐3 trial, 764 patients underwent CMR. LVH was defined by CMR and considered present if LV mass exceeded 77 (men) and 67 g/m2 (women). One hundred seventy‐eight patients (24%) had LVH. LVH was associated with a larger final infarct size (15% [interquartile range {IQR}, 10–21] vs 9% [IQR, 3–17]; P<0.001) and smaller final myocardial salvage index (0.6 [IQR, 0.5–0.7] vs 0.7 [IQR, 0.5–0.9]; P<0.001). The LVH group had a higher incidence of microvascular obstruction (66% vs 45%; P<0.001) and lower final LV ejection fraction (LVEF; 53% [IQR, 47–60] vs 61% [IQR, 55–65]; P<0.001). In a Cox regression analysis, LVH was associated with a higher risk of all‐cause mortality and readmission for heart failure (hazard ratio 2.59 [95% CI, 1.38–4.90], P=0.003). The results remained statistically significant in multivariable models.ConclusionsLVH is independently associated with larger infarct size, less myocardial salvage, higher incidence of microvascular obstruction, lower LVEF, and a higher risk of all‐cause mortality and incidence of heart failure in STEMI patients treated with primary percutaneous coronary intervention.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT01435408.

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“…The FB acquisition used in our study produced images of the heart with quality comparable to that of BH imaging, a technique that has been validated in studies in using human subjects (1) and animal models (9,10). Since many patients with previous cardiac events have difficulty with breath-holding, the ability to produce images without repeated periods of suspended respiration would increase the number of patients who would qualify for this test.…”

Section: Discussionmentioning

confidence: 93%

“…Two-dimensional breath-hold (BH) IR spoiled gradient-echo imaging has been validated in animal models and human studies (7)(8)(9)(10) and is currently the standard of reference for MR DHE imaging. Since one slice is acquired each BH, this technique requires many breath-holds for the evaluation of the entire left ventricle.…”

mentioning

confidence: 99%

Free‐breathing delayed hyperenhanced imaging of the myocardium: A clinical application of real‐time navigator echo imaging

Goldfarb

Shinnar

2006

Magnetic Resonance Imaging

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Purpose:To compare a free-breathing (FB) acquisition with the current standard of breath-holding (BH) in a clinical setting using identical two-dimensional MR pulse sequences for imaging of myocardial delayed hyperenhancement. Materials and Methods:Two-dimensional gadolinium-enhanced images were acquired using FB and BH techniques in 18 subjects to evaluate delayed enhancement of myocardial infarction. The FB acquisition used a navigator echo to monitor the position of the right hemidiaphragm for respiratory gating and correction. Visual analysis using a 16-segment model, quantitative signal difference to noise ratios, and percent left ventricle (LV) viability measurements for the two acquisition types were statistically compared.Results: An excellent agreement between two-dimensional BH and two-dimensional FB acquisitions was found. In one patient, a nontransmural infarct was seen only in the FB images. There were no statistically significant differences in the number of infarcted segments or the measured signal difference to noise ratios (SDNR) between the two methods. Linear regression and Bland Altman analysis of the percentage LV viable myocardium yielded a good fit and narrow limits of agreement. Conclusion:An FB navigator echo acquisition can be effectively used in the setting of myocardial delay hyperenhanced imaging. Image quality is similar or superior to that of BH imaging. RECENT STUDIES have shown that reversible myocardial dysfunction can be identified using gadoliniumenhanced MRI (1-5). Images of the myocardium are made after a delay of several minutes following T1 shortening contrast agent administration; this technique is often called "delayed hyperenhanced (DHE) imaging." Nonviable tissue is identified as having a slightly higher concentration than viable tissue of an intravenously injected gadolinium contrast agent. An inversion recovery (IR) T1 weighted sequence (6) is used to minimize the signal intensity from viable myocardium. The inversion time (TI) parameter of the pulse sequence, which is the time between the inversion pulse and the acquired data, is adjusted to minimize the image intensity of healthy myocardium. In these images, nonviable myocardium is identified as hyperenhancing regions.To reduce or eliminate artifacts from motion of the heart during the normal respiratory cycle, image data are most commonly acquired over several heartbeats using pulse sequences synchronized with the cardiac cycle and during suspended respiration. Two-dimensional breath-hold (BH) IR spoiled gradient-echo imaging has been validated in animal models and human studies (7-10) and is currently the standard of reference for MR DHE imaging. Since one slice is acquired each BH, this technique requires many breath-holds for the evaluation of the entire left ventricle. Single-slice BH MRI techniques (11,12) have been proposed and adopted to reduce acquisition time, increase image contrast, resolution, or spatial coverage, but BH-DHE techniques remain limited by BH time and patient cooperation.Free-breathing (F...

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Relationship of MRI Delayed Contrast Enhancement to Irreversible Injury, Infarct Age, and Contractile Function

Cited by 2,292 publications

References 35 publications

Optimal site selection and image fusion guidance technology to facilitate cardiac resynchronization therapy

Optimal site selection and image fusion guidance technology to facilitate cardiac resynchronization therapy

Left Ventricular Hypertrophy Is Associated With Increased Infarct Size and Decreased Myocardial Salvage in Patients With ST‐Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Free‐breathing delayed hyperenhanced imaging of the myocardium: A clinical application of real‐time navigator echo imaging

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