Skip to content


  • Oral presentation
  • Open Access

Myocardium at risk in ST-elevation myocardial infarction: comparison of T2-weighted edema imaging with the endocardial surface area assessed by magnetic resonance and validation against angiographic scoring

  • 1,
  • 1,
  • 1,
  • 1,
  • 1,
  • 1,
  • 1,
  • 1 and
  • 1
Journal of Cardiovascular Magnetic Resonance201113 (Suppl 1) :O31

  • Published:


  • Magnetic Resonance Imaging
  • Percutaneous Coronary Intervention
  • Infarct Size
  • Primary Percutaneous Coronary Intervention
  • Myocardial Salvage


T2-weighted magnetic resonance imaging (MRI) and the endocardial surface area (ESA) assessed by late gadolinium enhanced (LGE) have been introduced as relatively new methods for myocardium at risk assessment in ST-elevation myocardial infarction (STEMI).


However, data on the utility and validation of these techniques are limited. Purpose was therefore to assess the area at risk (AAR) with these 2 MRI methods and to compare them to the validated angiographic APPROACH-score in a large consecutive patient cohort.


One-hundred-ninety-seven patients undergoing primary percutaneous coronary intervention (PCI) in acute STEMI were included. AAR (assessed with T2-weighted edema imaging and the ESA method), infarct size and myocardial salvage were determined by MRI 2-4 days after primary PCI. Angiographic AAR scoring was performed by use of the APPROACH-score.


The AAR assessed by T2-weighted imaging showed a good correlation with the angiographic AAR (r=0.87; p<0.001), whereas the ESA showed only a moderate correlation either to T2-weighted imaging (r=0.56; p<0.001) and the APPROACH-Score (r=0.44; p<0.001). Mean AAR by ESA (20.0±11.7%LV) was significantly smaller than AAR by T2-weighted imaging and APPROACH-Score (p<0.001 respectively) and showed a significant negative dependence on myocardial salvage index.


Myocardium at risk and subsequently the salvaged AAR can be reliably assessed by T2-weighted edema imaging, whereas assessment of the AAR by ESA seems to be dependent on myocardial salvage and underestimates the AAR especially in patients with high myocardial salvage and aborted infarction. Thus, assessment of the AAR with the ESA method cannot be recommended.

Authors’ Affiliations

University of Leipzig - Heartcenter, Leipzig, Germany


© Fuernau et al; licensee BioMed Central Ltd. 2011

This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (<url></url>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.