Top

Journal of Cardiovascular Magnetic Resonance

Published in:

Open Access 01-12-2015 | Research

Time elapsed after contrast injection is crucial to determine infarct transmurality and myocardial functional recovery after an acute myocardial infarction

Authors: José F. Rodríguez-Palomares, José T. Ortiz-Pérez, Daniel C. Lee, Chiara Bucciarelli-Ducci, Paula Tejedor, Robert O Bonow, Edwin Wu

Published in: Journal of Cardiovascular Magnetic Resonance | Issue 1/2015

Abstract

Background

In acute myocardial infarction (MI), late Gadolinium enhancement (LGE) has been proposed to include the infarcted myocardium and area at risk. However, little information is available on the optimal timing after contrast injection to differentiate these 2 areas. Our aim was to determine in acute and chronic MI whether imaging time after contrast injection influences the LGE size that better predicts infarct size and functional recovery.

Methods

Subjects were evaluated by cardiovascular magnetic resonance (CMR) the first week (n = 60) and 3 months (n = 47) after a percutaneously revascularized STEMI. Inversion-recovery single-shot (ss-IR) imaging was acquired at multiple time points following contrast administration and compared to segmented inversion-recovery (seg-IR) sequences. Inversion time was properly adjusted and images were blinded, randomized and measured for LGE volumes.

Results

In acute MI, LGE volume decreased over several minutes (p = 0.005) with the greatest volume occurring at 3 minutes and the smallest at 25 minutes post-contrast injection; however, LGE volume remained constant over time in chronic MI (p = 0.886). Depending on the imaging time, in acute phase, a change in the transmurality index was also observed. A transmural infarction (>75%) at 25 minutes better predicted the absence of improvement in the wall motion score index (WMSI), a higher increase in left ventricular volumes and a lower ejection fraction compared to 10 minutes.

Conclusions

A change was observed in LGE volume in the minutes following contrast administration in acute but not in chronic MI. Infarct transmurality 25 minutes post-contrast injection better predicted infarct size and functional recovery at follow-up.

Choi KM, Kim RJ, Gubernikoff G, Vargas JD, Parker M, Judd RM. Transmural extent of acute myocardial infarction predicts long-term improvement in contractile function. Circulation. 2001;104(10):1101–7.CrossRefPubMed

Kim RJ, Wu E, Rafael A, Chen EL, Parker MA, Simonetti O, et al. The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. N Engl J Med. 2000;343(20):1445–53. doi:10.1056/NEJM200011163432003.CrossRefPubMed

Kim RJ, Fieno DS, Parrish TB, Harris K, Chen EL, Simonetti O, et al. Relationship of MRI delayed contrast enhancement to irreversible injury, infarct age, and contractile function. Circulation. 1999;100(19):1992–2002.CrossRefPubMed

Kim RJ, Albert TS, Wible JH, Elliott MD, Allen JC, Lee JC, et al. Performance of delayed-enhancement magnetic resonance imaging with gadoversetamide contrast for the detection and assessment of myocardial infarction: an international, multicenter, double-blinded, randomized trial. Circulation. 2008;117(5):629–37. doi:10.1161/CIRCULATIONAHA.107.723262.CrossRefPubMed

Oshinski JN, Yang Z, Jones JR, Mata JF, French BA. Imaging time after Gd-DTPA injection is critical in using delayed enhancement to determine infarct size accurately with magnetic resonance imaging. Circulation. 2001;104(23):2838–42.CrossRefPubMed

Saeed M, Bremerich J, Wendland MF, Wyttenbach R, Weinmann HJ, Higgins CB. Reperfused myocardial infarction as seen with use of necrosis-specific versus standard extracellular MR contrast media in rats. Radiology. 1999;213(1):247–57.CrossRefPubMed

Kim RJ, Chen EL, Lima JA, Judd RM. Myocardial Gd-DTPA kinetics determine MRI contrast enhancement and reflect the extent and severity of myocardial injury after acute reperfused infarction. Circulation. 1996;94(12):3318–26.CrossRefPubMed

Kramer CM, Rogers Jr WJ, Mankad S, Theobald TM, Pakstis DL, Hu YL. Contractile reserve and contrast uptake pattern by magnetic resonance imaging and functional recovery after reperfused myocardial infarction. J Am Coll Cardiol. 2000;36(6):1835–40.CrossRefPubMed

Rogers Jr WJ, Kramer CM, Geskin G, Hu YL, Theobald TM, Vido DA, et al. Early contrast-enhanced MRI predicts late functional recovery after reperfused myocardial infarction. Circulation. 1999;99(6):744–50.CrossRefPubMed

10.

Matsumoto H, Matsuda T, Miyamoto K, Shimada T, Mikuri M, Hiraoka Y. Peri-infarct zone on early contrast-enhanced CMR imaging in patients with acute myocardial infarction. JACC Cardiovasc Imaging. 2011;4(6):610–8. doi:10.1016/j.jcmg.2011.03.015.CrossRefPubMed

11.

Arai AE. Gadolinium can depict area at risk and myocardial infarction: a double-edged sword? JACC Cardiovasc Imaging. 2011;4(6):619–21. doi:10.1016/j.jcmg.2011.04.006.CrossRefPubMedCentralPubMed

12.

Huber A, Schoenberg SO, Spannagl B, Rieber J, Erhard I, Klauss V, et al. Single-shot inversion recovery TrueFISP for assessment of myocardial infarction. AJR Am J Roentgenol. 2006;186(3):627–33. doi:10.2214/AJR.04.0746.CrossRefPubMed

13.

Simonetti OP, Kim RJ, Fieno DS, Hillenbrand HB, Wu E, Bundy JM, et al. An improved MR imaging technique for the visualization of myocardial infarction. Radiology. 2001;218(1):215–23.CrossRefPubMed

14.

Wu E, Judd RM, Vargas JD, Klocke FJ, Bonow RO, Kim RJ. Visualisation of presence, location, and transmural extent of healed Q-wave and non-Q-wave myocardial infarction. Lancet. 2001;357(9249):21–8. doi:10.1016/S0140-6736(00)03567-4.CrossRefPubMed

15.

Pokorney SD, Rodriguez JF, Ortiz JT, Lee DC, Bonow RO, Wu E. Infarct healing is a dynamic process following acute myocardial infarction. J Cardiovasc Magn Reson: Off J Soc Cardiovasc Magn Reson. 2012;14:62. doi:10.1186/1532-429X-14-62.CrossRef

16.

Wu KC, Zerhouni EA, Judd RM, Lugo-Olivieri CH, Barouch LA, Schulman SP, et al. Prognostic significance of microvascular obstruction by magnetic resonance imaging in patients with acute myocardial infarction. Circulation. 1998;97(8):765–72.CrossRefPubMed

17.

Hombach V, Grebe O, Merkle N, Waldenmaier S, Hoher M, Kochs M, et al. Sequelae of acute myocardial infarction regarding cardiac structure and function and their prognostic significance as assessed by magnetic resonance imaging. Eur Heart J. 2005;26(6):549–57. doi:10.1093/eurheartj/ehi147.CrossRefPubMed

18.

Lima JA, Judd RM, Bazille A, Schulman SP, Atalar E, Zerhouni EA. Regional heterogeneity of human myocardial infarcts demonstrated by contrast-enhanced MRI. Potential mechanisms Circulation. 1995;92(5):1117–25.CrossRef

19.

Garcia-Dorado D, Theroux P, Elizaga J, Galinanes M, Solares J, Riesgo M, et al. Myocardial reperfusion in the pig heart model: infarct size and duration of coronary occlusion. Cardiovascular Res. 1987;21(7):537–44.CrossRef

20.

Orn S, Manhenke C, Anand IS, Squire I, Nagel E, Edvardsen T, et al. Effect of left ventricular scar size, location, and transmurality on left ventricular remodeling with healed myocardial infarction. Am J Cardiol. 2007;99(8):1109–14. doi:10.1016/j.amjcard.2006.11.059.CrossRefPubMed

21.

Ortiz-Perez JT, Meyers SN, Lee DC, Kansal P, Klocke FJ, Holly TA, et al. Angiographic estimates of myocardium at risk during acute myocardial infarction: validation study using cardiac magnetic resonance imaging. Eur Heart J. 2007;28(14):1750–8. doi:10.1093/eurheartj/ehm212.CrossRefPubMed

22.

Arheden H, Saeed M, Higgins CB, Gao DW, Ursell PC, Bremerich J, et al. Reperfused rat myocardium subjected to various durations of ischemia: estimation of the distribution volume of contrast material with echo-planar MR imaging. Radiology. 2000;215(2):520–8.CrossRefPubMed

23.

Klein C, Schmal TR, Nekolla SG, Schnackenburg B, Fleck E, Nagel E. Mechanism of late gadolinium enhancement in patients with acute myocardial infarction. J Cardiovasc Magn Reson: Off J Soc Cardiovasc Magn Reson. 2007;9(4):653–8. doi:10.1080/10976640601105614.CrossRef

24.

Reimer KA, Lowe JE, Rasmussen MM, Jennings RB. The wavefront phenomenon of ischemic cell death. 1. Myocardial infarct size vs duration of coronary occlusion in dogs. Circulation. 1977;56(5):786–94.CrossRefPubMed

25.

Solares J, Garcia-Dorado D, Oliveras J, Gonzalez MA, Ruiz-Meana M, Barrabes JA, et al. Contraction band necrosis at the lateral borders of the area at risk in reperfused infarcts. Observations in a pig model of in situ coronary occlusion. Virchows Archiv : Intl J Pathol. 1995;426(4):393–9.CrossRef

26.

Beek AM, Kuhl HP, Bondarenko O, Twisk JW, Hofman MB, van Dockum WG, et al. Delayed contrast-enhanced magnetic resonance imaging for the prediction of regional functional improvement after acute myocardial infarction. J Am Coll Cardiol. 2003;42(5):895–901.CrossRefPubMed

27.

Dall'Armellina E, Karia N, Lindsay AC, Karamitsos TD, Ferreira V, Robson MD, et al. Dynamic changes of edema and late gadolinium enhancement after acute myocardial infarction and their relationship to functional recovery and salvage index. Circ Cardiovasc Imaging. 2011;4(3):228–36. doi:10.1161/CIRCIMAGING.111.963421.CrossRefPubMedCentralPubMed

28.

Ibrahim T, Nekolla SG, Hornke M, Bulow HP, Dirschinger J, Schomig A, 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. J Am Coll Cardiol. 2005;45(4):544–52. doi:10.1016/j.jacc.2004.10.058.CrossRefPubMed

29.

Ingkanisorn WP, Rhoads KL, Aletras AH, Kellman P, Arai AE. Gadolinium delayed enhancement cardiovascular magnetic resonance correlates with clinical measures of myocardial infarction. J Am Coll Cardiol. 2004;43(12):2253–9. doi:10.1016/j.jacc.2004.02.046.CrossRefPubMed

30.

Amado LC, Gerber BL, Gupta SN, Rettmann DW, Szarf G, Schock R, et al. Accurate and objective infarct sizing by contrast-enhanced magnetic resonance imaging in a canine myocardial infarction model. J Am Coll Cardiol. 2004;44(12):2383–9. doi:10.1016/j.jacc.2004.09.020.CrossRefPubMed

31.

Hsu LY, Natanzon A, Kellman P, Hirsch GA, Aletras AH, Arai AE. Quantitative myocardial infarction on delayed enhancement MRI. Part I: Animal validation of an automated feature analysis and combined thresholding infarct sizing algorithm. J Magn Reson Imaging: JMRI. 2006;23(3):298–308. doi:10.1002/jmri.20496.CrossRefPubMed

Title: Time elapsed after contrast injection is crucial to determine infarct transmurality and myocardial functional recovery after an acute myocardial infarction
Authors: José F. Rodríguez-Palomares
José T. Ortiz-Pérez
Daniel C. Lee
Chiara Bucciarelli-Ducci
Paula Tejedor
Robert O Bonow
Edwin Wu
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: Journal of Cardiovascular Magnetic Resonance / Issue 1/2015
Electronic ISSN: 1532-429X
DOI: https://doi.org/10.1186/s12968-015-0139-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Time elapsed after contrast injection is crucial to determine infarct transmurality and myocardial functional recovery after an acute myocardial infarction

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2015

Gender specific patterns of age-related decline in aortic stiffness: a cardiovascular magnetic resonance study including normal ranges

Real-time aortic pulse wave velocity measurement during exercise stress testing

Extracellular volume quantification in isolated hypertension - changes at the detectable limits?

The association between cardiovascular risk and cardiovascular magnetic resonance measures of fibrosis: the Multi-Ethnic Study of Atherosclerosis (MESA)

Distal coronary embolization following acute myocardial infarction increases early infarct size and late left ventricular wall thinning in a porcine model

Myocardial T2* mapping: influence of noise on accuracy and precision