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 ,
Mark B. M. Hofman, PhD ,
Willem G. van Dockum, MD*,
Cees A. Visser, MD, PhD* and
Albert C. van Rossum, MD, PhD*
* Department of Cardiology, Amsterdam, The Netherlands
Department of Clinical Epidemiology and Biostatistics, Amsterdam, The Netherlands
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.
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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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