Document Detail

Cardiac MRI of myocardial salvage at the peri-infarct border zones after primary coronary intervention.
MedLine Citation:
PMID:  19429834     Owner:  NLM     Status:  MEDLINE    
The purpose of this study was to use cardiac MRI to define the morphology of the reversibly injured peri-infarct border zone in patients treated with primary percutaneous coronary intervention (PPCI) for acute ST elevation myocardial infarction. In 15 patients, T2-weighted myocardial edema imaging was used to identify the ischemic bed or area at risk (AAR), and late gadolinium enhancement imaging was used to measure infarct size. Images were coregistered, and the boundaries of edema and necrosis were defined using an edge-detection methodology. We observed that infarction always involved the subendocardium but showed variable transmural extension within the AAR. The mean infarct size was 22 +/- 19% (range: 8-48%), and the mean AAR was 34 +/- 12% (range: 20-57%). The infarcted myocardium was always smaller than the ischemic AAR and involved between 34% and 99% (mean 72 +/- 21%) of the ischemic bed primarily due to variation in transmural infarct extension. Although a lateral border zone of potentially viable myocardium was often present, its extent was limited (range: 0-11 mm, mean: 5 +/- 4 mm). As a result of this, infarcts occupied the majority (range: 70-100%, mean: 82 +/- 13%) of the width of the AAR. The mean fractional wall thickening in the infarcted, peri-infarcted, and remote myocardium was 3.6 +/- 16.0%, 40.5 +/- 26.4%, and 88.2 +/- 39.3%, respectively. These findings demonstrate that myocardial salvage is largely determined by epicardial limitation of the infarct within the ischemic AAR after PPCI. The lateral boundaries of necrosis approximate to the lateral extent of the ischemic bed and systolic wall motion abnormalities extend well beyond the infarct border zone.
Declan P O'Regan; Rizwan Ahmed; Clare Neuwirth; Yvonne Tan; Giuliana Durighel; Joseph V Hajnal; Imad Nadra; Simon J Corbett; Stuart A Cook
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-05-08
Journal Detail:
Title:  American journal of physiology. Heart and circulatory physiology     Volume:  297     ISSN:  1522-1539     ISO Abbreviation:  Am. J. Physiol. Heart Circ. Physiol.     Publication Date:  2009 Jul 
Date Detail:
Created Date:  2009-06-30     Completed Date:  2009-08-12     Revised Date:  2014-02-19    
Medline Journal Info:
Nlm Unique ID:  100901228     Medline TA:  Am J Physiol Heart Circ Physiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  H340-6     Citation Subset:  IM    
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MeSH Terms
Angioplasty, Balloon, Coronary*
Coronary Angiography
Edema, Cardiac / pathology
Image Processing, Computer-Assisted
Magnetic Resonance Angiography
Magnetic Resonance Imaging
Middle Aged
Myocardial Infarction / pathology*
Myocardial Ischemia / pathology
Myocardium / pathology*
Postoperative Period
Grant Support
MC_U120061309//Medical Research Council; MC_U120085815//Medical Research Council; //British Heart Foundation; //Medical Research Council

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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