Magnetic resonance imaging of persistent myocardial obstruction after myocardial infarction. A tool becoming increasingly important in clinical cardiology?

Excerpt

Aggressive reperfusion therapy using percutaneous coronary intervention (PCI) techniques has contributed significantly with the decrease of cardiac mortality after myocardial infarction in the last decade. This by limiting myocardial necrosis and infarct size [1]. Despite complete restoration of flow in the epicardial coronary artery after PCI, myocardial perfusion is not restored in up to 30% of patients due to microvascular obstruction [2]. Microvascular obstruction is known to be associated with a higher incidence of left ventricular remodeling, post infarct complications, congestive heart failure and death [3]. Imaging of the extent of microvascular obstruction is important because local delivery of pluripotent cells, having cardiomyogenic potential, in viable infarct borders might regenerate heart tissue [4]. The preferred way to detect microvascular obstruction with MRI is using gadolinium enhanced magnetic resonance imaging. This can be done using first-pass perfusion and with late gadolinium enhancement [5, 6]. …