Magnetic resonance imaging demonstrates improved regional systolic wall motion and thickening and myocardial perfusion of myocardial territories treated by laser myocardial revascularization
Roger J. Laham, MD* ,*,
Michael Simons, MD*,
Justin D. Pearlman, MD, PhD, ME*,
Kalon K. L. Ho, MD, MSc and
Donald S. Baim, MD
* Angiogenesis Research Center, Boston, Massachusetts, USA
Interventional Cardiology Section, Department of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
Interventional Cardiology Section, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Figure 1 Left anterior oblique cranial Biosense NOGA unipolar (left) and linear local shortening map (right) shows reduced anterolateral wall linear local shortening in red (regional function) with preserved unipolar voltage indicating viable but underperfused myocardium. Twenty-five laser channels were created using the Biosense Ho:YAG laser system (brown dots) in the "ischemic" zone (red) of the anterolateral wall.
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Figure 2 Functional imaging was performed during breath-hold using shared-center FLASH imaging producing 16 to 24 sequential image frames each (cine MR), collected over approximately 12 heartbeats to measure regional wall systolic thickening and motion. The target wall(s) was interrogated (arrow) using an automated algorithm and displayed as a function of time allowing the determination of target wall motion and thickening.
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Figure 3 Resting normal (black bars) and target (white bars, treated) wall thickening (top) and radial wall motion (bottom) showed improvement in the target wall function at 30 and 180 days. In addition, there was a significant improvement in normal wall motion at 180 days. *Statistical significance with a p < 0.05 by paired t test. ANOVA = analysis of variance.
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Figure 4 Myocardial perfusion/contrast arrival was assessed using MR imaging after bolus administration of gadodiamide, an MR contrast agent. Time sequence display of selected short axis diastolic images (top) shows contrast arrival to the right ventricle (closed arrow), then to the left ventricle (open arrow), followed by the left ventricular myocardium. The mean size of the delayed contrast arrival zone (underperfused area of the myocardium) was 14.5 ± 5.4% of the left ventricle at baseline. The size of the myocardial area demonstrating delayed contrast arrival was reduced significantly at one and six months, as compared to baseline. *Statistical significance with a p < 0.05 by paired t test. ANOVA = analysis of variance.
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