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Circ Cardiovasc Imaging. 2016 Jul;9(7). pii: e004376. doi: 10.1161/CIRCIMAGING.115.004376.

Extent of Myocardium at Risk for Left Anterior Descending Artery, Right Coronary Artery, and Left Circumflex Artery Occlusion Depicted by Contrast-Enhanced Steady State Free Precession and T2-Weighted Short Tau Inversion Recovery Magnetic Resonance Imaging.

Author information

1
From the Cardiac MR Group, Department of Clinical Physiology (D.N., E.H., M.C., A.H.A., H.E., H.A.) and Department of Cardiology (S.K., D.E.), Skåne University Hospital, Lund University, Sweden; Department of Radiology, Odense University Hospital, Denmark (E.-T.F.); Section for Interventional Cardiology, Division of Cardiovascular and Pulmonary Diseases, Department of Cardiology, Oslo University Hospital, Ullevaal, Norway (P.H.); Department of Cardiology B, Oslo University Hospital Ullevål, and Faculty of Medicine, University of Oslo, Norway (D.A.); and Laboratory of Medical Informatics, School of Medicine, Aristotle University of Thessaloniki, Greece (A.H.A.).
2
From the Cardiac MR Group, Department of Clinical Physiology (D.N., E.H., M.C., A.H.A., H.E., H.A.) and Department of Cardiology (S.K., D.E.), Skåne University Hospital, Lund University, Sweden; Department of Radiology, Odense University Hospital, Denmark (E.-T.F.); Section for Interventional Cardiology, Division of Cardiovascular and Pulmonary Diseases, Department of Cardiology, Oslo University Hospital, Ullevaal, Norway (P.H.); Department of Cardiology B, Oslo University Hospital Ullevål, and Faculty of Medicine, University of Oslo, Norway (D.A.); and Laboratory of Medical Informatics, School of Medicine, Aristotle University of Thessaloniki, Greece (A.H.A.). hakan.arheden@med.lu.se.

Abstract

BACKGROUND:

Contrast-enhanced steady state free precession (CE-SSFP) and T2-weighted short tau inversion recovery (T2-STIR) have been clinically validated to estimate myocardium at risk (MaR) by cardiovascular magnetic resonance while using myocardial perfusion single-photon emission computed tomography as reference standard. Myocardial perfusion single-photon emission computed tomography has been used to describe the coronary perfusion territories during myocardial ischemia. Compared with myocardial perfusion single-photon emission computed tomography, cardiovascular magnetic resonance offers superior image quality and practical advantages. Therefore, the aim was to describe the main coronary perfusion territories using CE-SSFP and T2-STIR cardiovascular magnetic resonance data in patients after acute ST-segment-elevation myocardial infarction.

METHODS AND RESULTS:

CE-SSFP and T2-STIR data from 2 recent multicenter trials, CHILL-MI and MITOCARE (n=215), were used to assess MaR. Angiography was used to determine culprit vessel. Of 215 patients, 39% had left anterior descending artery occlusion, 49% had right coronary artery occlusion, and 12% had left circumflex artery occlusion. Mean extent of MaR using CE-SSFP was 44±10% for left anterior descending artery, 31±7% for right coronary artery, and 30±9% for left circumflex artery. Using T2-STIR, MaR was 44±9% for left anterior descending artery, 30±8% for right coronary artery, and 30±12% for left circumflex artery. MaR was visualized in polar plots, and expected overlap was found between right coronary artery and left circumflex artery. Detailed regional data are presented for use in software algorithms as a priori information on the extent of MaR.

CONCLUSIONS:

For the first time, cardiovascular magnetic resonance has been used to show the main coronary perfusion territories using CE-SSFP and T2-STIR. The good agreement between CE-SSFP and T2-STIR from this study and myocardial perfusion single-photon emission computed tomography from previous studies indicates that these 3 methods depict MaR accurately in individual patients and at a group level.

CLINICAL TRIAL REGISTRATION:

URL: http://www.clinicaltrials.gov. Unique identifiers: NCT01379261 and NCT01374321.

KEYWORDS:

coronary occlusion; coronary vessels; magnetic resonance imaging; myocardial ischemia; myocardium

PMID:
27412659
DOI:
10.1161/CIRCIMAGING.115.004376
[Indexed for MEDLINE]

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