Document Detail


Characterization of microvascular dysfunction after acute myocardial infarction by cardiovascular magnetic resonance first-pass perfusion and late gadolinium enhancement imaging.
MedLine Citation:
PMID:  17060106     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: While both first-pass perfusion and late gadolinium enhancement by cardiovascular magnetic resonance (CMR) can assess coronary microvascular status in acute myocardial infarction (AMI), there are only limited data on their respective diagnostic utility. We aim to evaluate: the utility of first-pass perfusion and late gadolinium enhancement imaging in the detection and quantification of microvascular dysfunction after reperfused acute myocardial infarction, using TIMI frame count (TIMI FC) as the reference standard of microvascular assessment; and their relationship with infarct size and ventricular function. METHODS: First-pass perfusion and late gadolinium enhancement imaging were performed in 25 consecutive AMI patients (84% men, age 58 +/- 10) within 72 h of successful reperfusion. We assessed the myocardial extent of microvascular dysfunction using the size of the perfusion defect on first-pass perfusion (PD%) and the hypoenhanced core region within late gadolinium enhancement (MDEcore%). PD%, MDEcore%, and TIMI FC were analyzed independently of each other and with blinding to clinical data. We adjusted PD% and MDEcore% to the myocardial mass subtended by the infarct-related artery according to the 16-segment model. RESULTS: Median infarct size involved 13.9% (interquartile range: 8.5 to 22.2%) of the left ventricle and median left ventricular ejection fraction was 52% (interquartile range: 43 to 61%). PD% demonstrated evidence of microvascular dysfunction more frequently (84% vs. 36% of patients, p < 0.002) and involved a larger myocardial extent (23.5 +/- 17.5% vs. 3.5 +/- 7.7%, p < 0.001) compared to MDEcore%. PD% had strong correlations with TIMI FC (Spearman rho = 0.62, p < 0.001) and infarct size (rho = 0.64, p < 0.001), and a moderate correlation with LVEF (rho = -0.39, p = 0.055). MDEcore% also correlated with TIMI FC (rho = 0.54, p = 0.005) and infarct size (rho = 0.52, p < 0.01) but not with LVEF (p = NS). CONCLUSIONS: PD% appeared to provide a stronger noninvasive assessment of the microvascular function than MDEcore% and correlated well with prognostic markers such as left ventricular ejection fraction and infarct size. Future studies should consider quantitative analyses of both first-pass perfusion and late gadolinium enhancement imaging in the evaluation of novel therapies targeted to the microvasculature of the infarct-related artery.
Authors:
Andrew T Yan; C Michael Gibson; Eric Larose; Nagesh S Anavekar; Sui Tsang; Scott D Solomon; Glenn Reynolds; Raymond Y Kwong
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance     Volume:  8     ISSN:  1097-6647     ISO Abbreviation:  J Cardiovasc Magn Reson     Publication Date:  2006  
Date Detail:
Created Date:  2006-10-24     Completed Date:  2007-02-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9815616     Medline TA:  J Cardiovasc Magn Reson     Country:  United States    
Other Details:
Languages:  eng     Pagination:  831-7     Citation Subset:  IM    
Affiliation:
Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital Harvard Medical School, Boston, Massachusetts 02115, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Contrast Media
Coronary Angiography
Creatine Kinase / blood
Female
Gadolinium DTPA
Heart Ventricles / pathology
Humans
Image Enhancement
Magnetic Resonance Imaging, Cine*
Male
Microcirculation
Middle Aged
Myocardial Infarction / pathology*,  therapy
Myocardial Reperfusion*
Myocardium / pathology*
Pilot Projects
Prospective Studies
Stroke Volume / physiology
Ventricular Dysfunction, Left / physiopathology,  therapy
Chemical
Reg. No./Substance:
0/Contrast Media; 80529-93-7/Gadolinium DTPA; EC 2.7.3.2/Creatine Kinase

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