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Herz. 2018 Oct 15. doi: 10.1007/s00059-018-4741-z. [Epub ahead of print]

Evaluation of myocardial viability in myocardial infarction patients by magnetic resonance perfusion and delayed enhancement imaging.

Author information

1
Department of Cardiology, Second Affiliated Hospital of Kunming Medical University, 374 Dianmian road, Wuhua Area, 650101, Kunming, China.
2
Department of Cardiology, Second Affiliated Hospital of Kunming Medical University, 374 Dianmian road, Wuhua Area, 650101, Kunming, China. sunlinkm@sina.com.
3
Department of Radiology, Second Affiliated Hospital of Kunming Medical University, 650101, Kunming, China.
4
Department of Radiology, First Affiliated Hospital of Chengdu Medical College, 610500, Chengdu, China.

Abstract

OBJECTIVE:

Cardiovascular magnetic resonance imaging (CMR) has been established as a modality to detect myocardial viability. The aim of this study was to evaluate myocardial viability by observing transmural extent of infraction and microvascular perfusion level.

METHODS:

We performed CMR in 30 myocardial infarction (MI) patients within 7-10 days. At the 6‑month follow-up, CMR was used to evaluate the impact of abnormal reperfusion and observe the transmural extent of infraction on recovery of function.

RESULTS:

The left ventricle was divided into 16 segments using the American Heart Association classification. Infarcts were detected in 202 of the 480 segments (42%) by delayed enhancement magnetic resonance imaging (DE-MRI). According to first-pass myocardial perfusion, abnormal perfusion was detected in 278 of 480 segments (60%), reduced perfusion was identified in 173 of 278 (62%), and perfusion defects in 105 of 278 segments (38%). The results showed that the segments with abnormal perfusion were larger than in DE-MRI (P < 0.05), indicating that the area of abnormal perfusion segments extend significantly beyond the region of infarction. Microvascular perfusion with an infarcted region was lower compared to non-infarcted segments (P < 0.05). The extent of myocardial hyperenhancement correlated inversely with microvascular perfusion (P < 0.05). Segments with severe microvascular perfusion and >75% transmural infarction on the 7‑ to 10-day scan had markedly increased at the 6‑month follow-up (P < 0.01), indicating a lack of recovery of cardiac function.

CONCLUSIONS:

DE-MRI combined with microvascular perfusion may be effective to detect viable myocardium in patients with MI and may provide a means of predicting whether revascularization will be effective.

KEYWORDS:

Cardiovascular disease; Delayed enhancement magnetic resonance imaging; First-pass myocardial perfusion; Left ventricular dysfunction; Myocardial viability

PMID:
30324340
DOI:
10.1007/s00059-018-4741-z

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