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Early contrast-enhanced MRI predicts late functional recovery after reperfused myocardial infarction
W J Rogers1, C M Kramer, G Geskin
1Division of Cardiology, Department of Medicine, Allegheny General Hospital, Pittsburgh, PA 15212, USA.
Background:
We have observed 3 abnormal patterns on contrast-enhanced MRI early after reperfused myocardial infarction (MI): (1) absence of normal first-pass signal enhancement (HYPO), (2) normal first pass signal followed by hyperenhanced signal on delayed images (HYPER), or (3) both absence of normal first-pass enhancement and delayed hyperenhancement (COMB). This study examines the association between these patterns in the first week after MI and late recovery of myocardial contractile function by use of magnetic resonance myocardial tissue tagging.
Methods And Results:
Seventeen patients (14 men) with a mean age of 53+/-12 years were studied after a reperfused first MI. Contrast-enhanced images were acquired immediately after bolus administration of gadolinium and 7+/-2 minutes later. Tagged images were acquired at weeks 1 and 7. Circumferential segment shortening (%S) was measured in regions displaying HYPER, COMB, or HYPO contrast patterns and in remote regions (REMOTE) at weeks 1 and 7. At week 1, %S was depressed in HYPER, COMB, and HYPO (9+/-8%, 7+/-6%, and 5+/-4%, respectively) and were less than REMOTE (18+/-6%, P<0.003). However, in HYPER, %S improved at week 7 from 9+/-8% to 18+/-5% (P<0.001 versus week 1). In contrast, HYPO did not improve significantly (5+/-4% to 6+/-3%, P=NS) and COMB tended to improve 7+/-6% to 11+/-6% (P=0.06).
Conclusions:
HYPER has partially reversible dysfunction and represents predominantly viable myocardium. COMB shows borderline improvement and likely contains an admixture of viable and necrotic myocardium. HYPO shows little functional improvement at 7 weeks, presumably because of irreversible myocardial damage.
Insights
Magnetic resonance imaging patterns after myocardial infarction (MI) predict functional recovery. The HYPER pattern indicates viable myocardium with reversible dysfunction, while HYPO suggests irreversible damage.
Area of Science:
- Cardiovascular Imaging
- Myocardial Infarction Recovery
- Cardiac MRI Analysis
Background:
- Contrast-enhanced MRI reveals three patterns post-reperfusion myocardial infarction (MI): HYPO (no initial enhancement), HYPER (delayed hyperenhancement), and COMB (both).
- These patterns are assessed for their association with late recovery of myocardial contractile function.
Purpose of the Study:
- To investigate the relationship between early contrast-enhanced MRI patterns and late functional recovery after reperfused myocardial infarction.
- To differentiate myocardial viability and predict contractile function recovery based on MRI findings.
Main Methods:
- Seventeen patients with reperfused MI underwent contrast-enhanced MRI and myocardial tagging at 1 and 7 weeks.
- Circumferential segment shortening (%S) was measured in regions with HYPO, HYPER, COMB, and remote patterns.
Main Results:
- At week 1, %S was significantly depressed in all patterns (HYPER, COMB, HYPO) compared to remote regions.
- By week 7, %S improved significantly in HYPER (9±8% to 18±5%), indicating partial recovery.
- HYPO showed no significant improvement (5±4% to 6±3%), and COMB demonstrated borderline improvement (7±6% to 11±6%).
Conclusions:
- The HYPER pattern suggests predominantly viable myocardium with partially reversible dysfunction.
- The COMB pattern indicates a mix of viable and necrotic myocardium with limited functional improvement.
- The HYPO pattern is associated with irreversible myocardial damage and minimal functional recovery at 7 weeks.