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

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

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

View larger version (21K): [in a new window]   Figure 1 The cardiac magnetic resonance size of acute myocardial infarction correlates with peak troponin I. Circles indicate revascularized acute myocardial infarction (a); triangles indicate patients who did not undergo revascularization (b).

View larger version (23K): [in a new window]   Figure 2 The cardiac magnetic resonance size of acute myocardial infarction predicts left ventricular (LV) ejection fraction at time of follow-up scan.

View larger version (28K): [in a new window]   Figure 3 The transmural extent of delayed enhancement is inversely related to quantitative regional wall thickening (a: acute study, b: chronic study, p < 0.001 for both trends). For segments with <1 mm of wall thickening on the acute study, the improvement in wall thickening is much greater for segments that appear normal on delayed enhancement images compared with abnormal segments (c). There were too few segments with residual severe wall motion abnormalities on the acute study with <50% transmural extent of delayed enhancement to allow further stratification of the change in wall thickening (WT).

View larger version (70K): [in a new window]   Figure 4 Images demonstrating a decrease in the size and transmural extent of myocardial infarction in a patient. The images in the left column were performed one day after successful percutaneous intervention on an occluded right coronary artery. The images in the right column show the corresponding infarct images on follow-up.

View larger version (31K): [in a new window]   Figure 5 The cardiac magnetic resonance infarct size decreases between the acute and the follow-up cardiac magnetic resonance scan based on grams of myocardium with delayed enhancement (a) or percent of myocardium that showed delayed enhancement (b). For comparison purposes, similar measurements in patients with chronic myocardial infarction do not change significantly between serial cardiac magnetic resonance scans (c and d). LV = left ventricle.

View larger version (92K): [in a new window]   Figure 6 Changes in the amount of gadolinium delayed enhancement myocardium without net thinning of the left ventricular wall may represent partial volume effects as described in the "Discussion" section. Offsetting involution of the infarcted myocardium and hypertrophy of viable myocardium within pixels could explain serial changes on the delayed enhancement images. The first cardiac magnetic resonance scan (top row) was performed two days after acute percutaneous intervention on a circumflex coronary artery. The follow-up scan (bottom row) was performed two months later.