Relationship Between Transmural Extent of Necrosis and Quantitative Recovery of Regional Strains After Revascularization

• Published in: JACC. Cardiovascular imaging Vol. 3; no. 7; pp. 720 - 730
• Main Authors: Gerber, Bernhard L., MD, Darchis, Julie, MD, le Polain de Waroux, Jean-Benoît, MD, Legros, Gabin, MD, Pouleur, Anne-Catherine, MD, Vancraeynest, David, MD, Pasquet, Agnès, MD, Vanoverschelde, Jean-Louis, MD
• Format: Journal Article
• Language: English
• Published: United States 01-07-2010
• Subjects: Aged; Angioplasty, Balloon, Coronary; Belgium; Cardiovascular; Chronic Disease; Coronary Artery Bypass; Female; Humans; Image Interpretation, Computer-Assisted; Magnetic Resonance Imaging; Male; Middle Aged; Myocardial Contraction; Myocardial Infarction - complications; Myocardial Infarction - pathology; Myocardial Infarction - physiopathology; Myocardial Infarction - therapy; Myocardium - pathology; Necrosis; Predictive Value of Tests; Prospective Studies; Recovery of Function; Stroke Volume; Time Factors; Treatment Outcome; Ventricular Dysfunction, Left - etiology; Ventricular Dysfunction, Left - pathology; Ventricular Dysfunction, Left - physiopathology; Ventricular Dysfunction, Left - therapy; Ventricular Function, Left; Belgium; strain; DE; EF; Ecc; ejection fraction; Err; delayed enhancement; CI; myocardial infarction; CMR; LV; area under the receiver-operator characteristic curve; coronary artery bypass graft; MDCT; AUC; multidetector CT; Eulerian radial thickening strain; myocardial viability; Eulerian circumferential shortening strain; confidence interval; left ventricle/ventricular; CABG; cardiac magnetic resonance
• ISSN: 1936-878X; 1876-7591
• DOI: 10.1016/j.jcmg.2010.03.008

Objectives To better understand the quantitative relationship of recovery of regional and global dysfunction after revascularization in chronic infarcts with variable transmural extent of necrosis by delayed enhanced cardiac magnetic resonance. Background Studies relating transmurality of delayed enhanced magnetic resonance to functional recovery in dysfunctional myocardium using semiquantitative Likert scales have demonstrated the intermediate likelihood (50% probability) of recovery of dysfunction in subendocardial scars. Methods Forty-two patients with chronic left ventricular dysfunction due to coronary artery disease underwent tagged and delayed enhanced magnetic resonance before and 10 ± 7 months after revascularization (coronary artery bypass graft: 35, percutaneous transluminal coronary angioplasty: 7). Left ventricular ejection fraction and regional mid-myocardial Eulerian radial thickening strain (Err) and mid-myocardial, subendocardial, and subepicardial Eulerian circumferential shortening strain (Ecc) strains were quantified in 16 segments per patient before and after revascularization and related to pre-operatively measured transmurality of necrosis. Results At baseline, 256 of 672 segments were dysfunctional, having <2 SD (i.e., >−10%) mid-myocardial Ecc. The magnitude of recovery of mid-myocardial Ecc (r = −0.33, p < 0.01) was inversely correlated with transmurality of necrosis before revascularization. Segments with <25% necrosis improved mid-myocardial Ecc and Err. No significant improvement of mid-myocardial Ecc or Err occurred when transmurality was ≥25%. However, subendocardial Ecc improved up to 75% transmural necrosis. Receiver-operator characteristic analysis determined optimal sensitivity (54%) and specificity (82%) for normalization of mid-myocardial Ecc (to <−10% Ecc) at a cutoff value of ≥18% transmural necrosis. Improvement of left ventricular ejection fraction (from 35 ± 15% to 40 ± 7%, p < 0.001) was best predicted (67% sensitivity, 58% specificity) by the presence of <4.5 dysfunctional segments with <75% transmural necrosis. Conclusions The quantitative relationship between necrosis transmurality and improvement of regional and global dysfunction after revascularization is complex. Although improvement of recovery of regional mid-myocardial dysfunction after revascularization was observed only for scarring not exceeding 25% transmurality, global dysfunction significantly improved even when more extensive subendocardial scarring was revascularized.