Myocardium at risk in ST-elevation myocardial infarction: comparison of T2 edema imaging using magnetic resonance versus angiographic scoring
Journal of Cardiovascular Magnetic Resonance volume 12, Article number: O79 (2010)
The assessment of the area at risk (AAR) in acute myocardial infarction (AMI) with T2-weighted imaging using magnetic resonance imaging (MRI) is a relatively new method with only limited clinical data; yet, sufficient validating studies are lacking.
Purpose of this trial was to assess the AAR and myocardial salvage by MRI and to compare it to the validated angiographic APPROACH-score in a large consecutive patient cohort.
From November 2006 to February 2008 202 patients undergoing primary angioplasty in AMI with ST-elevation were enrolled. Myocardial salvage was assessed by MRI 2-4 days after primary PCI with measurement of the extension of myocardial edema in T2-weighted images and of infarct size with delayed enhancement imaging. Angiographic scoring was done by use of the APPROACH-score.
All images were assessable for measurements of the AAR, infarct size and consecutively myocardial salvage. All infarcts consistently revealed a pattern with both reversibly and irreversibly injured tissue. In contrast to the infarcted area, reversible damage was always transmural. The AAR in the MRI-studies showed a good correlation with the angiographic AAR (r = 0.870; p < 0.001). However, as shown by Bland-Altman-analyses there was a certain bias towards an overestimation of the AAR by MRI in comparison to angiographic scoring (35.7 ± 10.9%LV vs. 28.0 ± 10.5%LV, difference 7.7 ± 5.5 p < 0.001). The infarct size measured by MRI was 18.0 ± 11.6%LV. The calculated myocardial salvage was 17.7 ± 11.7%LV. The time from symptom-onset to reperfusion had a significant impact on the myocardial salvage.
AAR measurement by MRI shows excellent correlation to the angiographic APPROACH-score with slight overestimation. This might be explained by the former validation of the angiographic score by pathological studies mostly in human hearts without recent myocardial infarction.
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Fuernau, G.F., Franke, V., Eitel, I. et al. Myocardium at risk in ST-elevation myocardial infarction: comparison of T2 edema imaging using magnetic resonance versus angiographic scoring. J Cardiovasc Magn Reson 12 (Suppl 1), O79 (2010). https://doi.org/10.1186/1532-429X-12-S1-O79