CLINICAL STUDY: ACUTE CORONARY SYNDROMES
Contractile reserve and contrast uptake pattern by magnetic resonance imaging and functional recovery after reperfused myocardial infarction
Christopher M. Kramer, MD, FACC*,
Walter J. Rogers, Jr., MS ,
Sunil Mankad, MD, FACC,
Therese M. Theobald, MPH,
Diana L. Pakstis, RN and
Yong-Lin Hu, PhD
* Departments of Medicine and Radiology, University of Virginia Health System, Charlottesville, Virginia, USA
Department of Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
Manuscript received December 31, 1999;
revised manuscript received May 3, 2000,
accepted July 10, 2000.
Reprint requests and correspondence: Dr. Christopher M. Kramer, University of Virginia Health System, Departments of Medicine and Radiology, Box 800170, Charlottesville, Virginia 22908
ckramer{at}virginia.edu
OBJECTIVES
We hypothesized that contrast-enhanced and dobutamine tagged magnetic resonance imaging (MRI) could investigate microvascular integrity and contractile reserve of reperfused myocardial infarction (MI) in one examination.
BACKGROUND
In reperfused MI, microvascular integrity and contractile reserve are important determinants of functional recovery.
METHODS
Twenty-three patients with a reperfused first MI were studied. On day 3 ± 1 after MI, patients underwent tagged MRI at baseline and during infusion of 5 and 10 µg/kg/min of dobutamine followed by contrast-enhanced MRI (first pass and delayed imaging) after a bolus infusion of gadolinium-diethylenetriaminepenta-acetic acid. Tagged MRI was performed 9 ± 1 weeks later (follow-up). Eighty-four transmural regions with hyperenhancement on delayed contrast-enhanced images were defined as COMB (first pass hypoenhancement) or HYPER (normal first pass signal enhancement). Percent circumferential segment shortening was measured within the subendocardium and subepicardum of each region of HYPER or COMB at baseline, peak dobutamine and follow-up.
RESULTS
Shortening improved in COMB regions from 4 ± 1% at baseline to 10 ± 1% at peak dobutamine and 10 ± 1% at follow-up, respectively (p < 0.0003 vs. baseline for both). The HYPER regions likewise improved from 10 ± 1% at baseline to 16 ± 1% and 17 ± 1%, respectively (p < 0.0004 vs. baseline for both). Function within COMB regions was less than that of HYPER at baseline, peak dobutamine and follow-up (p < 0.0003 for all).
CONCLUSIONS
Dobutamine magnetic resonance tagging and contrast enhanced MRI are complementary in assessing functional recovery after reperfused MI. Regions of delayed contrast hyperenhancement demonstrate both contractile reserve and late functional recovery. However, if these regions demonstrate first pass contrast hypoenhancement, they are associated with greater myocardial damage.
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Abbreviations and Acronyms
| | CE | = contrast echocardiography | | COMB | = myocardial regions demonstrating first pass hypoenhancement and delayed hyperenhancement | | DE | = dobutamine echocardiography | | Gd-DTPA | = gadolinium-diethylenetriaminepenta-acetic acid | | HYPER | = myocardial regions demonstrating normal first pass enhancement and delayed hyperenhancement | | MI | = myocardial infarction | | MR | = magnetic resonance | | MRI | = magnetic resonance imaging | | %S | = percent intramyocardial circumferential shortening |
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