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1024 A novel CMR-based myocardial salvage index predicts left ventricular remodeling after acute myocardial infarction: insights from T2-weighted and late gadolinium enhancement imaging

Background

Late gadolinium enhancement (LGE) accurately identifies irreversible injury after acute myocardial infarction (AMI). T2-weighted imaging has the ability to quantify the area at risk in the same setting. We investigated the value of a novel myocardial salvage index based on the difference between the extents of T2-weighted abnormality and LGE to predict long-term left ventricular remodeling after AMI.

Methods

We enrolled 41 patients (31 males, 56 ± 11 y) 3 ± 2 days after successful infarct reperfusion by PCI. Thirty-five patients returned for follow up 15 ± 13 months (median 12 months) after the acute event. The CMR protocol consisted of cine steady state free precession, triple inversion recovery T2-weighted and late gadolinium enhancement imaging (10 minutes after the iv injection of gadolinium-DTPA). Left ventricular volumes and function were quantified independent from the tissue characterization analysis and by different observers. In the acute phase, T2-weighted and LGE images were analyzed by special software (CMR42R, CIRCLE, Calgary) to quantify volumes of abnormal signal, which were expressed as a percent of the total LV volume. The difference between T2 and LGE extents (T2-LGE) was then calculated as a measure of myocardial salvage. The primary end-points were the change in end-diastolic volume (delta-EDV) and end-systolic volume (delta-ESV) over time.

Results

T2-weighted abnormalities were detected only during the acute phase. T2-LGE but not LGE alone (p = 0.1) correlated with the time to reperfusion (r = -0.39; p = 0.014). Both T2-LGE (r = -0.52; p = 0.002) and LGE alone (r = 0.41; p = 0.018) correlated with delta EDV. T2-LGE correlated with delta-ESV (r = -0.39, p = 0.026) but LGE alone did not (p = 0.43).

The relation between T2-LGE, delta EDV and delta-ESV remained significant after correcting for the inter-study duration, time to reperfusion, ejection fraction and LGE extent.

Conclusion

We propose a myocardial salvage index based on the difference between T2-weighted abnormality and late gadolinium enhancement. This novel CMR-based parameter may have the potential to serve as a surrogate end-point in studies assessing the efficacy of infarct reperfusion strategies.

Author information

Correspondence to Hassan Abdel-Aty.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abdel-Aty, H., Zagrosek, A., Wassmuth, R. et al. 1024 A novel CMR-based myocardial salvage index predicts left ventricular remodeling after acute myocardial infarction: insights from T2-weighted and late gadolinium enhancement imaging. J Cardiovasc Magn Reson 10, A149 (2008). https://doi.org/10.1186/1532-429X-10-S1-A149

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Keywords

  • Acute Myocardial Infarction
  • Acute Myocardial Infarction
  • Late Gadolinium Enhancement
  • Ventricular Remodel
  • Left Ventricular Remodel