CLINICAL RESEARCH
Reproducibility of Chronic and Acute Infarct Size Measurement by Delayed Enhancement-Magnetic Resonance Imaging
Holger Thiele, MD*,*,
Mathias J.E. Kappl, MD*,
Stefan Conradi, MD ,
Josef Niebauer, MD, PhD*,
Rainer Hambrecht, MD* and
Gerhard Schuler, MD*
* Cardiology
Radiology, University of Leipzig-Heart Center, Leipzig, Germany
Manuscript received May 11, 2005;
accepted November 16, 2005.
* Reprint requests and correspondence: Dr. Holger Thiele, Department of Internal Medicine/Cardiology, University of Leipzig-Heart Center, Strümpellstr. 39, 14289 Leipzig, Germany
(Email: thielh{at}medizin.uni-leipzig.de).
OBJECTIVES: The aim of this study was to evaluate the reproducibility of acute and chronic infarct size (IS) by delayed enhancement (DE) magnetic resonance imaging (MRI).
BACKGROUND: Infarct size measurements can be used as surrogate end point to reduce the sample size in studies comparing different reperfusion strategies in myocardial infarction (MI). Delayed enhancement MRI is a rather new technique, and so far infarct IS reproducibility has not been established appropriately.
METHODS: In 21 patients (10 acute MI and 11 chronic MI), IS was assessed repeatedly on consecutive days by DE-MRI. Reproducibility, interobserver, and intraobserver variabilities were assessed and compared by the Bland-Altman method.
RESULTS: Acute and chronic IS were 17.1 ± 19.6% (range 5.1% to 69.8%) of LV mass (%LV) and 16.9 ± 9.9 %LV (range 2.0% to 36.0%), respectively. Infarct size difference (bias) between scan I and scan II was –0.5 %LV, and limits of agreement were ±2.4 %LV. Mean bias (–0.7 %LV) and limits of agreement (±3.2%) were slightly higher for acute in comparison with chronic MI with –0.4 ± 1.3 %LV. Intraobserver and interobserver variability was low with a mean bias of 0.3 %LV (limits of agreement ± 1.7 %LV) and –0.7 %LV (limits of agreement ± 2.2 %LV), respectively.
CONCLUSIONS: Infarct size measurement by DE-MRI is an excellent tool for IS assessment, owing to its excellent repeatability in chronic and acute MI. It has therefore the potential to serve as a surrogate end point to uncover advantages of new reperfusion strategies.
|
Abbreviations and Acronyms
| | DE = delayed enhancement | | IR = inversion-recovery | | IS = infarct size | | LV = left ventricle/ventricular | | MI = myocardial infarction | | MRI = magnetic resonance imaging | | %LV = percentage infarct size of left ventricular mass | | SPECT = single-photon emission computed tomography |
|
Related Article
-
Positively Magnetic North
- Timothy F. Christian
J. Am. Coll. Cardiol. 2006 47: 1646-1648.
[Full Text]
[PDF]
This article has been cited by other articles:
|
|
|
|
 
I. Eitel, S. Desch, S. de Waha, G. Fuernau, M. Gutberlet, G. Schuler, and H. Thiele
Sex Differences in Myocardial Salvage and Clinical Outcome in Patients With Acute Reperfused ST-Elevation Myocardial Infarction: Advances in Cardiovascular Imaging
Circ Cardiovasc Imaging,
January 1, 2012;
5(1):
119 - 126.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
I. Eitel, S. Desch, S. de Waha, G. Fuernau, M. Gutberlet, G. Schuler, and H. Thiele
Long-term prognostic value of myocardial salvage assessed by cardiovascular magnetic resonance in acute reperfused myocardial infarction
Heart,
December 15, 2011;
97(24):
2038 - 2045.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. R. Patel, R. W. Smalling, H. Thiele, H. X. Barnhart, Y. Zhou, P. Chandra, D. Chew, M. Cohen, J. French, D. Perera, et al.
Intra-aortic Balloon Counterpulsation and Infarct Size in Patients With Acute Anterior Myocardial Infarction Without Shock: The CRISP AMI Randomized Trial
JAMA,
September 28, 2011;
306(12):
1329 - 1337.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Fuernau, I. Eitel, V. Franke, L. Hildebrandt, J. Meissner, S. de Waha, P. Lurz, M. Gutberlet, S. Desch, G. Schuler, et al.
Myocardium at Risk in ST-Segment Elevation Myocardial Infarction: Comparison of T2-Weighted Edema Imaging With the MR-Assessed Endocardial Surface Area and Validation Against Angiographic Scoring
J. Am. Coll. Cardiol. Img.,
September 1, 2011;
4(9):
967 - 976.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
I. Eitel, F. von Knobelsdorff-Brenkenhoff, P. Bernhardt, I. Carbone, K. Muellerleile, A. Aldrovandi, M. Francone, S. Desch, M. Gutberlet, O. Strohm, et al.
Clinical Characteristics and Cardiovascular Magnetic Resonance Findings in Stress (Takotsubo) Cardiomyopathy
JAMA,
July 20, 2011;
306(3):
277 - 286.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
I. Eitel, K. Kubusch, O. Strohm, S. Desch, Y. Mikami, S. de Waha, M. Gutberlet, G. Schuler, M. G. Friedrich, and H. Thiele
Prognostic Value and Determinants of a Hypointense Infarct Core in T2-Weighted Cardiac Magnetic Resonance in Acute Reperfused ST-Elevation-Myocardial Infarction
Circ Cardiovasc Imaging,
July 1, 2011;
4(4):
354 - 362.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Thiele, I. Eitel, C. Meinberg, S. Desch, A. Leuschner, D. Pfeiffer, A. Hartmann, U. Lotze, W. Strauss, G. Schuler, et al.
Randomized Comparison of Pre-Hospital-Initiated Facilitated Percutaneous Coronary Intervention Versus Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction Very Early After Symptom Onset: The LIPSIA-STEMI Trial (Leipzig Immediate Prehospital Facilitated Angioplasty in ST-Segment Myocardial Infarction)
J. Am. Coll. Cardiol. Intv.,
June 1, 2011;
4(6):
605 - 614.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
I. Eitel, P. Blase, V. Adams, L. Hildebrand, S. Desch, G. Schuler, and H. Thiele
Growth-differentiation factor 15 as predictor of mortality in acute reperfused ST-elevation myocardial infarction: insights from cardiovascular magnetic resonance
Heart,
April 15, 2011;
97(8):
632 - 640.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Ganesha Babu, J. Malcolm Walker, D. M. Yellon, and D. J. Hausenloy
Peri-procedural myocardial injury during percutaneous coronary intervention: an important target for cardioprotection
Eur. Heart J.,
January 1, 2011;
32(1):
23 - 31.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Schwitter and J. Bremerich
Chapter 21 Cardiac magnetic resonance imaging
The ESC Textbook of Acute and Intensive Cardiac Care,
December 1, 2010;
1(1):
med-9780199584314-chapter - med-9780199584314-chapter.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. de Waha, S. Desch, I. Eitel, G. Fuernau, J. Zachrau, A. Leuschner, M. Gutberlet, G. Schuler, and H. Thiele
Impact of early vs. late microvascular obstruction assessed by magnetic resonance imaging on long-term outcome after ST-elevation myocardial infarction: a comparison with traditional prognostic markers
Eur. Heart J.,
November 1, 2010;
31(21):
2660 - 2668.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
I. Eitel, S. Desch, G. Fuernau, L. Hildebrand, M. Gutberlet, G. Schuler, and H. Thiele
Prognostic Significance and Determinants of Myocardial Salvage Assessed by Cardiovascular Magnetic Resonance in Acute Reperfused Myocardial Infarction
J. Am. Coll. Cardiol.,
June 1, 2010;
55(22):
2470 - 2479.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Thiele, L. Hildebrand, C. Schirdewahn, I. Eitel, V. Adams, G. Fuernau, S. Erbs, A. Linke, K. W. Diederich, M. Nowak, et al.
Impact of High-Dose N-Acetylcysteine Versus Placebo on Contrast-Induced Nephropathy and Myocardial Reperfusion Injury in Unselected Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: The LIPSIA-N-ACC (Prospective, Single-Blind, Placebo-Controlled, Randomized Leipzig Immediate PercutaneouS Coronary Intervention Acute Myocardial Infarction N-ACC) Trial
J. Am. Coll. Cardiol.,
May 18, 2010;
55(20):
2201 - 2209.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. W. Kim, A. Farzaneh-Far, and R. J. Kim
Cardiovascular Magnetic Resonance in Patients With Myocardial Infarction: Current and Emerging Applications
J. Am. Coll. Cardiol.,
January 5, 2010;
55(1):
1 - 16.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Kitabata, T. Imanishi, T. Kubo, S. Takarada, M. Kashiwagi, H. Matsumoto, H. Tsujioka, H. Ikejima, Y. Arita, K. Okochi, et al.
Coronary Microvascular Resistance Index Immediately After Primary Percutaneous Coronary Intervention as a Predictor of the Transmural Extent of Infarction in Patients With ST-Segment Elevation Anterior Acute Myocardial Infarction
J. Am. Coll. Cardiol. Img.,
March 1, 2009;
2(3):
263 - 272.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Thiele, J. Friedenberger, I. Eitel, G. Furnau, E. Grebe, S. Erbs, A. Linke, S. Mobius-Winkler, G. Schuler, K. Schindler, et al.
Response to Letter Regarding Article, "Intracoronary Compared With Intravenous Bolus Abciximab Application in Patients With ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention"
Circulation,
January 27, 2009;
119(3):
e20 - e20.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. H. Kwon, C. M. Halley, T. P. Carrigan, V. Zysek, Z. B. Popovic, R. Setser, P. Schoenhagen, R. C. Starling, S. D. Flamm, and M. Y. Desai
Extent of left ventricular scar predicts outcomes in ischemic cardiomyopathy patients with significantly reduced systolic function: a delayed hyperenhancement cardiac magnetic resonance study.
J. Am. Coll. Cardiol. Img.,
January 1, 2009;
2(1):
34 - 44.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Engblom, E. Hedstrom, E. Heiberg, G. S. Wagner, O. Pahlm, and H. Arheden
Rapid Initial Reduction of Hyperenhanced Myocardium After Reperfused First Myocardial Infarction Suggests Recovery of the Peri-Infarction Zone: One-Year Follow-Up by MRI
Circ Cardiovasc Imaging,
January 1, 2009;
2(1):
47 - 55.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
I. Eitel, F. Behrendt, K. Schindler, D. Kivelitz, M. Gutberlet, G. Schuler, and H. Thiele
Differential diagnosis of suspected apical ballooning syndrome using contrast-enhanced magnetic resonance imaging
Eur. Heart J.,
November 1, 2008;
29(21):
2651 - 2659.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Thiele, K. Schindler, J. Friedenberger, I. Eitel, G. Furnau, E. Grebe, S. Erbs, A. Linke, S. Mobius-Winkler, D. Kivelitz, et al.
Intracoronary Compared With Intravenous Bolus Abciximab Application in Patients With ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: The Randomized Leipzig Immediate Percutaneous Coronary Intervention Abciximab IV Versus IC in ST-Elevation Myocardial Infarction Trial
Circulation,
July 1, 2008;
118(1):
49 - 57.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. S.H. Cheng, J. B. Selvanayagam, M. Jerosch-Herold, W. J. van Gaal, T. D. Karamitsos, S. Neubauer, and A. P. Banning
Percutaneous treatment of chronic total coronary occlusions improves regional hyperemic myocardial blood flow and contractility insights from quantitative cardiovascular magnetic resonance imaging.
J. Am. Coll. Cardiol. Intv.,
February 1, 2008;
1(1):
44 - 53.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Thiele, M. J. Kappl, A. Linke, S. Erbs, E. Boudriot, A. Lembcke, D. Kivelitz, and G. Schuler
Influence of time-to-treatment, TIMI-flow grades, and ST-segment resolution on infarct size and infarct transmurality as assessed by delayed enhancement magnetic resonance imaging
Eur. Heart J.,
June 6, 2007;
(2007)
ehm173v1.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. F. Christian
Positively Magnetic North
J. Am. Coll. Cardiol.,
April 18, 2006;
47(8):
1646 - 1648.
[Full Text]
[PDF]
|
|
|
|
