Semi-quantitative assessment of resting perfusion in chronic myocardial infarction
© Patel et al; licensee BioMed Central Ltd. 2015
Published: 3 February 2015
Based on observations from cardiovascular magnetic resonance (CMR) imaging, it is not clear whether chronic myocardial infarction (MI) is associated with abnormal perfusion at rest. Our aim was to investigate this question using semi-quantitative analysis of resting myocardial perfusion to compare areas of infarct and remote myocardium in patients with known coronary anatomy.
We identified 19 patients who underwent regadenoson stress CMR (1.5T, Philips), had MI confirmed by late gadolinium enhancement (LGE), and underwent invasive coronary angiography within 6 months of CMR. Stress perfusion images were obtained during first pass of Gadolinium contrast agent one minute after regadenoson (0.4mg IV bolus) injection, and followed by reversal with aminophylline (75-125 mg), rest perfusion and late gadolinium enhancement (LGE) imaging 10-15 minutes later. Resting time-intensity curves were generated for a region of interest (ROI) in the area of MI, remote myocardium, and blood pool (Medis). Myocardial curves were used to obtain maximal up-slopes and normalized by the blood pool. Up-slopes were compared between the infarcted and remote myocardial ROIs.
There was no significant difference between the slopes in the infarcted and remote myocardium (0.31 ± 0.17 vs 0.32 ± 0.18 1/s) irrespective of presence of significant stenosis (>70%), or in ROIs supplied by arteries with or without significant stenosis (0.31 ± 0.18 vs 0.32 ± 0.17 1/s) irrespective of presence of scar.
Resting myocardial perfusion on CMR images does not reflect either the presence of chronic MI or underlying coronary patency. Accordingly, normal resting perfusion should not be used to rule out either significant stenosis or the presence of an underlying MI.
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 (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.