Performance of CMR Methods for Differentiating Acute From Chronic MI
Martijn W Smulders1, Sebastiaan C A M Bekkers1, Han W Kim2
1Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands.
JACC. Cardiovascular Imaging
|May 19, 2015
Summary
Cardiac MRI markers help differentiate acute from chronic myocardial infarction (MI). T2-weighted imaging is specific for infarcts under 6 months, while microvascular obstruction and wall thickening indicate recent MI (<1 month).
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- T2-weighted cardiac magnetic resonance (CMR) is used to differentiate acute from chronic myocardial infarction (MI).
- Previous studies had limited diagnostic accuracy and compared extreme infarct ages, not evaluating other informative CMR methods.
Purpose of the Study:
- To assess the performance of cardiac magnetic resonance (CMR) methods for discriminating acute from chronic myocardial infarction (MI).
Main Methods:
- 221 CMR studies were performed in 117 patients post-ST-segment elevation myocardial infarction.
- Imaging markers included T2 hyperintensity (double inversion recovery turbo spin echo - DIR-TSE), microvascular obstruction (MO), and increased end-diastolic wall thickness (EDWT).
Main Results:
- T2-DIR-TSE hyperintensity decreased with infarct age but persisted up to 6 months.
- MO and increased EDWT sharply dropped after 1 month.
- T2-DIR-TSE sensitivity/specificity/accuracy was 88%/66%/77%; MO or increased EDWT was 73%/97%/85% for acute MI. An algorithm incorporating CMR markers achieved 80% accuracy in classifying infarct age.
Conclusions:
- T2-DIR-TSE hyperintensity is specific for infarcts <6 months old.
- MO and increased EDWT are specific for infarcts <1 month old.
- Combining multiple CMR markers provides a more precise assessment of myocardial infarction age.
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