Retrospective determination of the area at risk for reperfused acute myocardial infarction with T2-weighted cardiac magnetic resonance imaging : Histopathological and displacement encoding with stimulated echoes (DENSE) functional validations

• Published in: Circulation (New York, N.Y.) Vol. 113; no. 15; pp. 1865 - 1870
• Main Authors: ALETRAS, Anthony H, TILAK, Gauri S, NATANZON, Alex, HSU, Li-Yueh, GONZALEZ, Felix M, HOYT, Robert F, ARAI, Andrew E
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 18-04-2006
• Subjects: Animals; Biological and medical sciences; Blood and lymphatic vessels; Blood. Blood coagulation. Reticuloendothelial system; Cardiology. Vascular system; Coronary heart disease; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Dogs; Echocardiography - methods; Edema, Cardiac - diagnosis; Heart; Heart - physiopathology; Magnetic Resonance Imaging; Medical sciences; Microspheres; Myocardial Infarction - diagnosis; Myocardial Infarction - physiopathology; Myocardial Infarction - therapy; Myocardial Reperfusion; Myocardium - pathology; Pharmacology. Drug treatments; Recovery of Function; Reproducibility of Results; Risk Factors; Time Factors; Myocardial infarction; Edema; magnetic resonance imaging; Histopathology; Heart disease; Contractility; Risk factor; Cardiovascular disease; myocardial strain; Myocardial disease; Nuclear magnetic resonance imaging
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.105.576025

The aim of this study was to determine whether edema imaging by T2-weighted cardiac magnetic resonance (CMR) imaging could retrospectively delineate the area at risk in reperfused myocardial infarction. We hypothesized that the size of the area at risk during a transient occlusion would be similar to the T2-weighted hyperintense region observed 2 days later, that the T2-weighted hyperintense myocardium would show partial functional recovery after 2 months, and that the T2 abnormality would resolve over 2 months.
Seventeen dogs underwent a 90-minute coronary artery occlusion, followed by reperfusion. The area at risk, as measured with microspheres (9 animals), was comparable to the size of the hyperintense zone on T2-weighted images 2 days later (43.4+/-3.3% versus 43.0+/-3.4% of the left ventricle; P=NS), and the 2 measures correlated (R=0.84). The infarcted zone was significantly smaller (23.1+/-3.7; both P<0.001). To test whether the hyperintense myocardium would exhibit partial functional recovery over time, 8 animals were imaged on day 2 and 2 months later. Systolic strain was mapped with displacement encoding with stimulated echoes. Edema, as detected by a hyperintense zone on T2-weighted images, resolved, and regional radial systolic strain partially improved from 4.9+/-0.7 to 13.1+/-1.5 (P=0.001) over 2 months.
These findings are consistent with the premise that the T2 abnormality depicts the area at risk, a zone of reversibly and irreversibly injured myocardium associated with reperfused subendocardial infarctions. The persistence of postischemic edema allows T2-weighted CMR to delineate the area at risk 2 days after reperfused myocardial infarction.