CLINICAL RESEARCH: CARDIAC IMAGING
The Salvaged Area at Risk in Reperfused Acute Myocardial Infarction as Visualized by Cardiovascular Magnetic Resonance
Matthias G. Friedrich, MD*,*,
Hassan Abdel-Aty, MD*, ,
Andrew Taylor, MD ,
Jeanette Schulz-Menger, MD,
Daniel Messroghli, MD and
Rainer Dietz, MD
* Stephenson Cardiovascular Magnetic Resonance Centre at the Libin Cardiovascular Institute of Alberta, Departments of Cardiac Sciences and Radiology, University of Calgary, Calgary, Alberta, Canada
Franz-Volhard-Klinik, Helios-Klinikum Berlin, Kardiologie, Charité Campus Berlin-Buch, Humboldt-Universität zu Berlin, Berlin, Germany
Baker Heart Research Institute, Melbourne, Australia.
Manuscript received November 6, 2007;
revised manuscript received December 19, 2007,
accepted January 6, 2008.
* Reprint requests and correspondence: Dr. Matthias G. Friedrich, Stephenson CMR Centre at the Libin Cardiovascular Institute of Alberta, Departments of Cardiac Sciences and Radiology, University of Calgary, 1403 29th Street NW, Calgary, Alberta T2N 2T9, Canada. (Email: matthias.friedrich{at}ucalgary.ca).
Objectives: We aimed to characterize the tissue changes within the perfusion bed of infarct-related vessels in patients with acutely reperfused myocardial infarction (MI) using cardiovascular magnetic resonance (CMR).
Background: Even in successful early revascularization, intermittent coronary artery occlusion affects the entire perfusion bed, also referred to as the area at risk. The extent of the salvaged area at risk contains prognostic information and may serve as a therapeutic target. Cardiovascular magnetic resonance can visualize the area at risk; yet, clinical data have been lacking.
Methods: We studied 92 patients with acute MI and successful reperfusion 3 ± 3 days after the event and 18 healthy control subjects. Breath-hold T2-weighted and contrast-enhanced ("late enhancement") CMR were used to visualize the reversible and the irreversible myocardial injury, respectively.
Results: All reperfused infarcts consistently revealed a pattern with both reversibly and irreversibly injured tissue. In contrast to the infarcted area, reversible damage was always transmural, exceeding the infarct in its maximal extent by 16 ± 11% (absolute difference of the area of maximal infarct expansion 38 ± 15% vs. 22 ± 10%; p < 0.0001). None of the controls had significant T2 signal intensity abnormalities.
Conclusions: In patients with reperfused MI, CMR visualizes both reversible and irreversible injury. This allows for quantifying the extent of the salvaged area after revascularization as an important parameter for clinical decision-making and research.
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Abbreviations and Acronyms
| | CMR = cardiovascular magnetic resonance | | CNR = contrast-to-noise ratio | | ECG = electrocardiogram | | Gd-DTPA = gadolinium diethylene triamine penta-acetic acid | | LE = late enhancement | | MI = myocardial infarction | | ROI = region of interest | | SI = signal intensity | | SNR = signal-to-noise ratio |
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