Acute myocardial infarction: serial cardiac MR imaging shows a decrease in delayed enhancement of the myocardium during the 1st week after reperfusion.

PURPOSE To evaluate the time course of delayed gadolinium enhancement of infarcted myocardium by using serial contrast agent-enhanced (CE) cardiac magnetic resonance (MR) images obtained during the acute, subacute, and chronic stages of infarction. MATERIALS AND METHODS The study protocol was reviewed and approved by the local ethics committee, and written informed consent was obtained. Seventeen patients with reperfused acute myocardial infarction (AMI) underwent cine and CE cardiac MR a median of 1, 7, 35, and 180 days after reperfusion. Infarct size determined on the basis of delayed enhancement MR imaging at different times was compared by using nonparametric tests and Bland-Altman analysis. Extent of myocardial enhancement was compared with single photon emission computed tomographic (SPECT) measures of infarct size with Spearman correlation. Regional myocardial enhancement extent and contractility were analyzed with nonparametric tests. RESULTS Infarct size was 18.3% of total myocardial LV volume on day 1 after AMI and decreased to 12.9% on day 7, 11.3% on day 35, and 11.6% on day 180 (all P < .001). Estimated infarct size on day 7, as compared with day 1 enhancement size, declined by 57.1% within the epicardium and by 6.3% within the endocardium (both P < .001). Infarct size on day 7 showed only minor changes at subsequent imaging and yielded a high correlation with SPECT measurements of infarct size (r = 0.84). Infarct size on day 7 inversely correlated with long-term wall thickening (P < .0001) and allowed prediction of contractile function. CONCLUSION In patients with AMI and successful coronary reperfusion, the size of delayed gadolinium enhancement at CE cardiac MR imaging significantly diminished during the 1st week after infarction. Thus, timing of CE cardiac MR imaging is crucial for accurate measurement of myocardial infarct size early after AMI.

[1]  J. Schulz-Menger,et al.  The salvaged area at risk in reperfused acute myocardial infarction as visualized by cardiovascular magnetic resonance. , 2008, Journal of the American College of Cardiology.

[2]  T. Hackl,et al.  Diagnostic value of contrast-enhanced magnetic resonance imaging and single-photon emission computed tomography for detection of myocardial necrosis early after acute myocardial infarction. , 2007, Journal of the American College of Cardiology.

[3]  W. Stevenson,et al.  Characterization of the Peri-Infarct Zone by Contrast-Enhanced Cardiac Magnetic Resonance Imaging Is a Powerful Predictor of Post–Myocardial Infarction Mortality , 2006, Circulation.

[4]  R. F. Hoyt,et al.  Cardiac magnetic resonance imaging , 2004, Postgraduate Medical Journal.

[5]  Filippo Cademartiri,et al.  Effects of primary angioplasty for acute myocardial infarction on early and late infarct size and left ventricular wall characteristics. , 2006, Journal of the American College of Cardiology.

[6]  K. Takeda,et al.  Late gadolinium-enhanced magnetic resonance imaging in acute and chronic myocardial infarction. Improved prediction of regional myocardial contraction in the chronic state by measuring thickness of nonenhanced myocardium. , 2005, Journal of the American College of Cardiology.

[7]  Stephan G Nekolla,et al.  Quantitative measurement of infarct size by contrast-enhanced magnetic resonance imaging early after acute myocardial infarction: comparison with single-photon emission tomography using Tc99m-sestamibi. , 2005, Journal of the American College of Cardiology.

[8]  A. Jaffe,et al.  The quantification of infarct size. , 2004, Journal of the American College of Cardiology.

[9]  Jeroen J. Bax,et al.  Quantification of myocardial infarct size and transmurality by contrast-enhanced magnetic resonance imaging in men. , 2004, The American journal of cardiology.

[10]  Gerhard Adam,et al.  Acute myocardial infarction: evaluation with first-pass enhancement and delayed enhancement MR imaging compared with 201Tl SPECT imaging. , 2004, Radiology.

[11]  Peter Kellman,et al.  Gadolinium delayed enhancement cardiovascular magnetic resonance correlates with clinical measures of myocardial infarction. , 2004, Journal of the American College of Cardiology.

[12]  S. Nekolla,et al.  Prognostic value of myocardial salvage achieved by reperfusion therapy in patients with acute myocardial infarction. , 2004, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[13]  Udo Sechtem,et al.  Cardiovascular Magnetic Resonance Assessment of Human Myocarditis: A Comparison to Histology and Molecular Pathology , 2004, Circulation.

[14]  Dan W Rettmann,et al.  Accurate and Objective Infarct Sizing by Contrast-enhanced Magnetic Resonance Imaging in a Canine Myocardial Infarction Model , 2022 .

[15]  A. Zeiher,et al.  Infarct Remodeling After Intracoronary Progenitor Cell Treatment in Patients With Acute Myocardial Infarction (TOPCARE-AMI): Mechanistic Insights From Serial Contrast-Enhanced Magnetic Resonance Imaging , 2003, Circulation.

[16]  R. Kim,et al.  Contrast-enhanced MRI and routine single photon emission computed tomography (SPECT) perfusion imaging for detection of subendocardial myocardial infarcts: an imaging study , 2003, The Lancet.

[17]  Imaging time after Gd-DTPA injection is critical in using delayed enhancement to determine infarct size accurately with magnetic resonance imaging. , 2002, Circulation.

[18]  S. Nekolla,et al.  Myocardial salvage after coronary stenting plus abciximab versus fibrinolysis plus abciximab in patients with acute myocardial infarction: a randomised trial , 2002, The Lancet.

[19]  B. Schnackenburg,et al.  Assessment of Myocardial Viability With Contrast-Enhanced Magnetic Resonance Imaging: Comparison With Positron Emission Tomography , 2002, Circulation.

[20]  C. Higgins,et al.  Magnetic Resonance Characterization of the Peri-Infarction Zone of Reperfused Myocardial Infarction With Necrosis-Specific and Extracellular Nonspecific Contrast Media , 2001, Circulation.

[21]  O. Simonetti,et al.  The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. , 2000, The New England journal of medicine.

[22]  R. Kim,et al.  Early Assessment of Myocardial Salvage by Contrast-Enhanced Magnetic Resonance Imaging , 2000, Circulation.

[23]  M. Schwaiger,et al.  Coronary stenting plus platelet glycoprotein IIb/IIIa blockade compared with tissue plasminogen activator in acute myocardial infarction. Stent versus Thrombolysis for Occluded Coronary Arteries in Patients with Acute Myocardial Infarction Study Investigators. , 2000, The New England journal of medicine.

[24]  C. Higgins,et al.  Reperfused rat myocardium subjected to various durations of ischemia: estimation of the distribution volume of contrast material with echo-planar MR imaging. , 2000, Radiology.

[25]  O. Simonetti,et al.  Relationship of MRI delayed contrast enhancement to irreversible injury, infarct age, and contractile function. , 1999, Circulation.

[26]  C. Higgins,et al.  Reperfused myocardial infarction as seen with use of necrosis-specific versus standard extracellular MR contrast media in rats. , 1999, Radiology.

[27]  E R McVeigh,et al.  Magnitude and time course of microvascular obstruction and tissue injury after acute myocardial infarction. , 1998, Circulation.

[28]  R. Kim,et al.  Myocardial Gd-DTPA kinetics determine MRI contrast enhancement and reflect the extent and severity of myocardial injury after acute reperfused infarction. , 1996, Circulation.

[29]  R. Judd,et al.  Physiological basis of myocardial contrast enhancement in fast magnetic resonance images of 2-day-old reperfused canine infarcts. , 1995, Circulation.

[30]  E. Atalar,et al.  Regional heterogeneity of human myocardial infarcts demonstrated by contrast-enhanced MRI. Potential mechanisms. , 1995, Circulation.

[31]  B. Gersh,et al.  Infarct size after acute myocardial infarction measured by quantitative tomographic 99mTc sestamibi imaging predicts subsequent mortality. , 1995, Circulation.

[32]  B. Gersh,et al.  Thrombolysis and Myocardial Salvage Results of Clinical Trials and the Animal Paradigm‐ Paradoxic or Predictable? , 1993, Circulation.

[33]  P. V. van Dijkman,et al.  Acute, subacute, and chronic myocardial infarction: quantitative analysis of gadolinium-enhanced MR images. , 1991, Radiology.

[34]  N. Yamada,et al.  Serial assessment of myocardial infarction by using gated MR imaging and Gd-DTPA. , 1989, AJR. American journal of roentgenology.

[35]  E. Braunwald,et al.  Myocardial reperfusion, limitation of infarct size, reduction of left ventricular dysfunction, and improved survival. Should the paradigm be expanded? , 1989, Circulation.

[36]  R. Peshock,et al.  Gadolinium-DTPA-enhanced nuclear magnetic resonance imaging of reperfused myocardium: identification of the myocardial bed at risk. , 1988, Journal of the American College of Cardiology.

[37]  J. Lowe,et al.  The Wavefront Phenomenon of Ischemic Cell Death: 1. Myocardial Infarct Size vs Duration of Coronary Occlusion in Dogs , 1977, Circulation.