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J Am Coll Cardiol, 2004; 43:2253-2259, doi:10.1016/j.jacc.2004.02.046
© 2004 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: MAGNETIC RESONANCE AND COMPUTED TOMOGRAPHIC IMAGING

Gadolinium delayed enhancement cardiovascular magnetic resonance correlates with clinical measures of myocardial infarction

W. Patricia Ingkanisorn, MD*{dagger}, Kenneth L. Rhoads, MD*{dagger}, Anthony H. Aletras, PhD*{dagger}, Peter Kellman, PhD* and Andrew E. Arai, MD*{dagger},*

* National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
{dagger} Suburban Hospital, Bethesda, Maryland, USA

Manuscript received April 4, 2003; revised manuscript received December 24, 2003, accepted February 3, 2004.

* Reprint requests and correspondence: Dr. Andrew E. Arai, Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, MSC 1061, Building 10, Room B1D-416, Bethesda, Maryland 20892-1061, USA.
araia{at}nih.gov

OBJECTIVES: The current study tested the hypothesis that gadolinium delayed enhancement assessment of infarct size correlates with clinical indices of myocardial infarction (MI) in humans. Acute infarct mass by cardiac magnetic resonance (CMR) was compared with peak troponin I, acute and chronic left ventricular (LV) systolic function, and chronic infarct mass in patients imaged after recent acute MI.

BACKGROUND: Cardiac magnetic resonance accurately determines myocardial viability in patients with chronic ischemic heart disease but is not well validated for recent MI.

METHODS: Patients with first acute MI (n = 33) or chronic MI (n = 10) underwent cine CMR followed by gadolinium delayed enhancement imaging. A follow-up CMR scan was performed on 20 of the 33 acute MI patients and all of the chronic MI patients.

RESULTS: In patients with acute percutaneous coronary intervention, acute MI mass correlated with peak troponin I (r = 0.83, p < 0.001, n = 23). In the 20 acute infarct patients with follow-up CMR scans, the acute infarct size correlated well with the follow-up LV ejection fraction (r = 0.86, p < 0.001). The transmural extent of delayed enhancement imaged acutely correlated inversely with wall thickening measured acutely (p < 0.001) and at follow-up (p < 0.001). Although chronic infarct size was reproducible (11 ± 4% vs. 12 ± 7%, p = NS), acute infarct size decreased from 16 ± 12% to 11 ± 9% (p < 0.003).

CONCLUSION: In humans imaged shortly after acute MI, gadolinium delayed enhancement acute CMR infarct size correlates with acute and chronic indices of infarct size but will appear to diminish in size on follow-up.

Abbreviations and Acronyms
  CMR = cardiac magnetic resonance
  Gd-DTPA = gadolinium diethyltriaminepentaacetic acid
  LV = left ventricle/ventricular
  MI = myocardial infarction




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