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J Am Coll Cardiol, 2003; 42:895-901, doi:10.1016/S0735-1097(03)00835-0
© 2003 by the American College of Cardiology Foundation
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CLINICAL RESEARCH

Delayed contrast-enhanced magnetic resonance imaging for the prediction of regional functional improvement after acute myocardial infarction

Aernout M. Beek, MD*,*, Harald P. Kühl, MD*, Olga Bondarenko, MD*, Jos W. R. Twisk, PhD{dagger}, Mark B. M. Hofman, PhD{ddagger}, Willem G. van Dockum, MD*, Cees A. Visser, MD, PhD* and Albert C. van Rossum, MD, PhD*

* Department of Cardiology, Amsterdam, The Netherlands
{dagger} Department of Clinical Epidemiology and Biostatistics, Amsterdam, The Netherlands
{ddagger} Department of Clinical Physics and Informatics, Vrije Universiteit Medical Center, Amsterdam, The Netherlands

Manuscript received August 27, 2002; revised manuscript received February 17, 2003, accepted March 7, 2003.

* Reprint requests and correspondence: Dr. Aernout M. Beek, Department of Cardiology, VU Medical Center, De Boelelaan 1117, Amsterdam 1007 MB, The Netherlands.
am.beek{at}vumc.nl

OBJECTIVES: We evaluated whether delayed contrast-enhanced magnetic resonance imaging (DCE-MRI) using an extracellular contrast agent could predict improvement of dysfunctional but viable myocardium after acute reperfused myocardial infarction (MI).

BACKGROUND: The transmural extent of hyperenhancement at DCE-MRI has been related to improvement of function in reperfused MI. However, evidence is still limited, and earlier reports have produced conflicting results regarding the significance of contrast patterns after infarction.

METHODS: Thirty patients (mean age 59 ± 11 years, 27 males) underwent cine MRI and DCE-MRI 7 ± 3 days after a first reperfused acute MI and follow-up cine MRI at 13 ± 3 weeks. Segmental wall thickening and segmental extent of hyperenhancement were scored in 1,689 segments.

RESULTS: Of 500 dysfunctional segments, 273 (55%) improved at follow-up. There was no difference in likelihood of improvement or complete functional recovery between segments with 0% and 1% to 25% hyperenhancement. The likelihood of improvement of segments without hyperenhancement was 2.9, 14.3, and 20 times higher than that of segments with 26% to 50%, 51% to 75%, and >75% hyperenhancement, respectively (p < 0.001). The likelihood of complete functional recovery of segments without hyperenhancement was 3.8, 11.1, and 50 times higher than that of segments with 26% to 50%, 51% to 75%, and >75% hyperenhancement, respectively (p < 0.001).

CONCLUSIONS: In patients with recent reperfused MI, functional improvement of stunned myocardium is predicted by DCE-MRI.

Abbreviations and Acronyms
  AMI = acute myocardial infarction
  CK = creatine kinase
  DCE = delayed contrast-enhanced
  DTPA = diethylenetriamine pentaacetic acid
  ECG = electrocardiogram
  EF = ejection fraction
  MI = myocardial infarction
  MRI = magnetic resonance imaging
  PTCA = percutaneous transluminal coronary angioplasty
  SEH = segmental extent of hyperenhancement
  SEHth = SEH scored after thresholding the window setting of contrast images
  SWT = segmental wall thickening
  TI = inversion time




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