TY - JOUR
T1 - Assessment of microvascular obstruction and prediction of short-term remodeling after acute myocardial infarction: Cardiac MR Imaging study
AU - Nijveldt, R.
AU - Hofman, M.B.M.
AU - Hirsch, A.
AU - Beek, A.M.
AU - Umans, V.A.
AU - Algra, P.R.
AU - Piek, J.J.
AU - van Rossum, A.C.
PY - 2009
Y1 - 2009
N2 - Purpose: To evaluate which cardiac magnetic resonance (MR) imaging technique for detection of microvascular obstruction (MVO) best predicts left ventricular (LV) remodeling after acute myocardial infarction (MI). Materials and Methods: This study had local ethics committee approval; all patients gave written informed consent. Sixty-three patients with first acute MI, treated with primary stent placement and optimal medical therapy, underwent cine MR imaging at 4-7 days and at 4 months after MI. Presence of MVO was qualitatively evaluated at baseline by using three techniques: (a) a single-shot saturation-recovery gradient-echo first-pass perfusion sequence (early hypoenhancement), mean time, 1.09 minutes +/- 0.07 (standard deviation) after contrast material administration; (b) a three-dimensional segmented saturation-recovery gradient-echo sequence (intermediate hypoenhancement), mean time, 2.17 minutes +/- 0.26; and (c) a two-dimensional segmented inversion-recovery gradient-echo late gadolinium enhancement sequence (late hypoenhancement), mean time, 13.32 minutes +/- 1.26. Contrast-to-noise ratios (CNRs) were calculated from the signal-to-noise ratios of the infarcted myocardium and MVO areas. Univariable linear regression analysis was used to identify the predictive value of each MR imaging technique. Results: Early hypoenhancement was detected in 44 (70%) of 63 patients; intermediate hypoenhancement, in 39 (62%); and late hypoenhancement, in 37 (59%). Late hypoenhancement was the strongest predictor of change in LV end-diastolic and end-systolic volumes over time (beta = 14.3 , r = 0.40, P = .001 and beta = 11.3, r = 0.44, P <.001, respectively), whereas intermediate and late hypoenhancement had comparable predictive values of change in LV ejection fraction (beta = -3.1, r = -0.29, P = .02 and beta = -2.8, r = -0.27, P = .04, respectively). CNR corrected for spatial resolution was significantly superior for late enhancement compared with the other sequences (P <.001). Conclusion: By using cardiac MR imaging, late hypoenhancement is the best prognostic marker of LV remodeling, with highest CNR between the infarcted myocardium and MVO regions. (C) RSNA, 2008
AB - Purpose: To evaluate which cardiac magnetic resonance (MR) imaging technique for detection of microvascular obstruction (MVO) best predicts left ventricular (LV) remodeling after acute myocardial infarction (MI). Materials and Methods: This study had local ethics committee approval; all patients gave written informed consent. Sixty-three patients with first acute MI, treated with primary stent placement and optimal medical therapy, underwent cine MR imaging at 4-7 days and at 4 months after MI. Presence of MVO was qualitatively evaluated at baseline by using three techniques: (a) a single-shot saturation-recovery gradient-echo first-pass perfusion sequence (early hypoenhancement), mean time, 1.09 minutes +/- 0.07 (standard deviation) after contrast material administration; (b) a three-dimensional segmented saturation-recovery gradient-echo sequence (intermediate hypoenhancement), mean time, 2.17 minutes +/- 0.26; and (c) a two-dimensional segmented inversion-recovery gradient-echo late gadolinium enhancement sequence (late hypoenhancement), mean time, 13.32 minutes +/- 1.26. Contrast-to-noise ratios (CNRs) were calculated from the signal-to-noise ratios of the infarcted myocardium and MVO areas. Univariable linear regression analysis was used to identify the predictive value of each MR imaging technique. Results: Early hypoenhancement was detected in 44 (70%) of 63 patients; intermediate hypoenhancement, in 39 (62%); and late hypoenhancement, in 37 (59%). Late hypoenhancement was the strongest predictor of change in LV end-diastolic and end-systolic volumes over time (beta = 14.3 , r = 0.40, P = .001 and beta = 11.3, r = 0.44, P <.001, respectively), whereas intermediate and late hypoenhancement had comparable predictive values of change in LV ejection fraction (beta = -3.1, r = -0.29, P = .02 and beta = -2.8, r = -0.27, P = .04, respectively). CNR corrected for spatial resolution was significantly superior for late enhancement compared with the other sequences (P <.001). Conclusion: By using cardiac MR imaging, late hypoenhancement is the best prognostic marker of LV remodeling, with highest CNR between the infarcted myocardium and MVO regions. (C) RSNA, 2008
U2 - https://doi.org/10.1148/radiol.2502080739
DO - https://doi.org/10.1148/radiol.2502080739
M3 - Article
C2 - 19164698
SN - 0033-8419
VL - 250
SP - 363
EP - 370
JO - Radiology
JF - Radiology
IS - 2
ER -