The Use of Contrast-Enhanced Magnetic Resonance Imaging to Identify Reversible Myocardial Dysfunction

Kim, Raymond J.; Wu, Edwin; Rafael, Allen; Chen, Enn Ling; Parker, Michele; Simonetti, Orlando P.; Klocke, Francis J.; Bonow, Robert O.; Judd, Robert M.

doi:10.1056/nejm200011163432003

Cited by 2,885 publications

(1,651 citation statements)

References 30 publications

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“…In contrast to HFrEF, where obstructive CAD is a major consideration in the evaluation and management of patients, CAD has received little attention in HFpEF 190, 191, 192, 193. Though abnormal relaxation is the first mechanical manifestation of myocardial ischemia,194, 195, 196 acute coronary artery syndromes seldom precipitate HFpEF decompensation or present as HFpEF 100, 197.…”

Section: Cad Phenotypementioning

confidence: 99%

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

Samson

Jaiswal

Ennezat

et al. 2016

JAHA

107

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Section: Cad Phenotypementioning

confidence: 99%

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

Samson

Jaiswal

Ennezat

et al. 2016

JAHA

107

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“…LGE magnetic resonance imaging is commonly used for the detection of myocardial infarction1, 2, 3, 4; however, many patients with cardiovascular disease cannot receive gadolinium because of impaired renal function 14. Noncontrast magnetic resonance imaging approaches based on the measurement of myocardial relaxation rates,34, 35 magnetization transfer,36 and apparent diffusivity21 have been reported; however, with the exception of T1 mapping–based techniques, these approaches remain experimental.…”

Section: Discussionmentioning

confidence: 99%

“…In ischemic cardiomyopathy, delineation of the extent of infarction and the area of viable myocardium plays an important role in patient management and the assessment of long‐term prognosis 1, 2, 3, 4. Myocardial tissue characterization is also of value in the diagnosis and assessment of a number of nonischemic cardiomyopathies 5, 6, 7.…”

Section: Introductionmentioning

confidence: 99%

“…A variety of imaging modalities and approaches have been used to assess myocardial injury, infiltration, and viability, most notably late gadolinium enhancement (LGE),1, 2, 3, 5, 6, 7 and positron emission tomography 10, 11, 12. LGE has emerged as a leading technique for tissue characterization of the myocardium; however, several issues complicate its use.…”

Section: Introductionmentioning

confidence: 99%

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Myocardial Scar Delineation Using Diffusion Tensor Magnetic Resonance Tractography

Mekkaoui

Jackowski

Kostis

et al. 2018

JAHA

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BackgroundLate gadolinium enhancement (LGE) is the current standard for myocardial scar delineation. In this study, we introduce the tractographic propagation angle (PA), a metric of myofiber curvature (degrees/unit distance) derived from diffusion tensor imaging (DTI), and compare its use to LGE and invasive scar assessment by endocardial voltage mapping.Methods and Results DTI was performed on 7 healthy human volunteers, 5 patients with myocardial infarction, 6 normal mice, and 7 mice with myocardial infarction. LGE to delineate the infarct and border zones was performed with a 2‐dimensional inversion recovery gradient‐echo sequence. Ex vivo DTI was performed on 5 normal human and 5 normal sheep hearts. Endocardial electroanatomic mapping and subsequent ex vivo DTI was performed on 5 infarcted sheep hearts. PA in the normal human hearts varied smoothly and was generally <4. The mean PA in the infarct zone was significantly elevated (10.34±1.02 versus 4.05±0.45, P<0.05). Regions with a PA ≤4 consistently had a bipolar voltage ≥1.5 mV, whereas those with PA values between 4 and 10 had voltages between 0.5 and 1.5 mV. A PA threshold >4 was the most accurate DTI‐derived measure of infarct size and demonstrated the greatest correlation with LGE (r=0.95).ConclusionsWe found a strong correlation between infarct size by PA and LGE in both mice and humans. There was also an inverse relationship between PA values and endocardial voltage. The use of PA may enable myocardial scar delineation and characterization of arrhythmogenic substrate without the need for exogenous contrast agents.

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“…Analysis is based on studies demonstrating improvement in radial contractility (myocardial thickening) following revascularization in hypo‐ or akinetic segments without substantial transmural fibrosis 1, 2. With >75% transmural fibrosis, minimal improvement in radial contractility can be expected.…”

Section: Introductionmentioning

confidence: 99%

Longitudinal shortening of sub‐epicardial myocytes in severe ischaemic cardiomyopathy: insights from gadolinium contrast cardiac magnetic resonance imaging

et al. 2017

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We present two patients with three‐vessel disease and severely depressed left ventricular (LV) systolic function where viability analysis by cardiac magnetic resonance imaging demonstrated areas of near‐transmural sub‐endocardial fibrosis and hence little chance of regaining systolic function as judged by conventional analysis from radial function. Despite the pessimistic cardiac magnetic resonance imaging analysis, however, the patients underwent full revascularization and regained impressive increases in LV systolic function mainly based on improved longitudinal systolic segment function. The cases highlight that sub‐epicardial, longitudinally oriented myocytes can contribute to overall LV systolic function and suggest taking their ‘piston‐function’ into consideration when analysing viability.

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The Use of Contrast-Enhanced Magnetic Resonance Imaging to Identify Reversible Myocardial Dysfunction

Abstract: Reversible myocardial dysfunction can be identified by contrast-enhanced MRI before coronary revascularization.

Cited by 2,885 publications

References 30 publications

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

Myocardial Scar Delineation Using Diffusion Tensor Magnetic Resonance Tractography

Longitudinal shortening of sub‐epicardial myocytes in severe ischaemic cardiomyopathy: insights from gadolinium contrast cardiac magnetic resonance imaging

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