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Journal of Cardiovascular Magnetic Resonance

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Open Access 01-12-2017 | Research

Extra-cellular expansion in the normal, non-infarcted myocardium is associated with worsening of regional myocardial function after acute myocardial infarction

Authors: Pankaj Garg, David A. Broadbent, Peter P. Swoboda, James R.J. Foley, Graham J. Fent, Tarique A. Musa, David P. Ripley, Bara Erhayiem, Laura E. Dobson, Adam K. McDiarmid, Philip Haaf, Ananth Kidambi, Saul Crandon, Pei G. Chew, R. J. van der Geest, John P. Greenwood, Sven Plein

Published in: Journal of Cardiovascular Magnetic Resonance | Issue 1/2017

Abstract

Background

Expansion of the myocardial extracellular volume (ECV) is a surrogate measure of focal/diffuse fibrosis and is an independent marker of prognosis in chronic heart disease. Changes in ECV may also occur after myocardial infarction, acutely because of oedema and in convalescence as part of ventricular remodelling. The objective of this study was to investigate changes in the pattern of distribution of regional (normal, infarcted and oedematous segments) and global left ventricular (LV) ECV using semi-automated methods early and late after reperfused ST-elevation myocardial infarction (STEMI).

Methods

Fifty patients underwent cardiovascular magnetic resonance (CMR) imaging acutely (24 h–72 h) and at convalescence (3 months). The CMR protocol included: cines, T2-weighted (T2 W) imaging, pre−/post-contrast T1-maps and LGE-imaging. Using T2 W and LGE imaging on acute scans, 16-segments of the LV were categorised as normal, oedema and infarct. 800 segments (16 per-patient) were analysed for changes in ECV and wall thickening (WT).

Results

From the acute studies, 325 (40.6%) segments were classified as normal, 246 (30.8%) segments as oedema and 229 (28.6%) segments as infarct. Segmental change in ECV between acute and follow-up studies (Δ ECV) was significantly different for normal, oedema and infarct segments (0.8 ± 6.5%, −1.78 ± 9%, −2.9 ± 10.9%, respectively; P < 0.001). Normal segments which demonstrated deterioration in wall thickening at follow-up showed significantly increased Δ ECV compared with normal segments with preserved wall thickening at follow up (1.82 ± 6.05% versus −0.10 ± 6.88%, P < 0.05).

Conclusion

Following reperfused STEMI, normal myocardium demonstrates subtle expansion of the extracellular volume at 3-month follow up. Segmental ECV expansion of normal myocardium is associated with worsening of contractile function.

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Title: Extra-cellular expansion in the normal, non-infarcted myocardium is associated with worsening of regional myocardial function after acute myocardial infarction
Authors: Pankaj Garg
David A. Broadbent
Peter P. Swoboda
James R.J. Foley
Graham J. Fent
Tarique A. Musa
David P. Ripley
Bara Erhayiem
Laura E. Dobson
Adam K. McDiarmid
Philip Haaf
Ananth Kidambi
Saul Crandon
Pei G. Chew
R. J. van der Geest
John P. Greenwood
Sven Plein
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: Journal of Cardiovascular Magnetic Resonance / Issue 1/2017
Electronic ISSN: 1532-429X
DOI: https://doi.org/10.1186/s12968-017-0384-0

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Extra-cellular expansion in the normal, non-infarcted myocardium is associated with worsening of regional myocardial function after acute myocardial infarction

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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