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Remote myocardial dysfunction after acute anterior myocardial infarction: impact of left ventricular shape on regional function

A magnetic resonance myocardial tagging study

Jan Bogaert, MD^*, Hilde Bosmans, PhD^* , Alex Maes, MD^*, Paul Suetens, PhD, Guy Marchal, MD^* and Frank E. Rademakers, MD^*

^* Department of Nuclear Medicine, the Interdisciplinary Research Unit for Radiological Imaging, University Hospitals, Leuven, Belgium and
Department of Cardiology, Radiology, and the Interdisciplinary Research Unit for Radiological Imaging, University Hospitals, Leuven, Belgium

View larger version (26K): [in a new window]   Figure 1 Regional strain analysis with MR tagging. By means of MR tagging along the cardiac short and long axes, the LV wall is divided in 32 small cuboids (three-dimensional [3D] reconstruction). Each cuboid is defined by four epicardial and four endocardial node points. The strains are expressed in a local cardiac coordinate system for each epicardial and endocardial node point. The axes are radial (R), circumferential (C) and longitudinal (L).

View larger version (32K): [in a new window]   Figure 2 Normal and shear strains. At the left, a "nondeformed" myocardial cube is shown at end-diastole. The deformation of the cube at end-systole, shown at the right, can be analyzed by means of a combination of three normal strains (left) and three shear strains (right). CL-shear = circumferential–longitudinal shear strain; CR-shear = circumferential–radial shear strain; EPI = epicardium; LR-shear = longitudinal–radial shear strain.

View larger version (27K): [in a new window]   Figure 3 Regional ejection fraction.

View larger version (99K): [in a new window]   Figure 4 Magnetic resonance tagging in a normal volunteer (A) and in a patient with an acute anterior MI (B), with corresponding PET study (C). A and B, Magnetic resonance tagging study. Horizontal long-axis view (top) and vertical long-axis view (bottom). Five tag lines are parallelly oriented in the short-axis direction and equally spread over the LV. Note the differences in apical sphericity between the control subjects and patients with an anterior MI. C, Positron emission tomographic study. Data are represented in bull’s eyes: 13NH3 map (left) and 18FDG map (right). The middle of the bull’s eye corresponds to the LV apex, whereas the periphery corresponds to the LV base. The anterior wall is above, the lateral wall to the right, the inferior wall below and the LV septum to the left of the bull’s eye. A reduction in flow or metabolism is represented as a dark area. Note the severe reduction in flow and metabolism in the anteroapical region extending to the septum.

View larger version (42K): [in a new window]   Figure 5 Endocardial and epicardial longitudinal strain. *p < 0.0001. #p = 0.02.

View larger version (18K): [in a new window]   Figure 6 Longitudinal–radial shear strain. Open bars = patients; hatched bars = control subjects. *p < 0.0001.

View larger version (36K): [in a new window]   Figure 7 Endocardial (A) and epicardial (B) regional ejection fraction. Open bars = patients; hatched bars = control subjects. *p < 0.0001.