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The relationship of gray zone and infarct core in the Iceland MI study
Journal of Cardiovascular Magnetic Resonance volume 18, Article number: P99 (2016)
Background
Gray zone or infarct heterogeneity, defined as the admixture of necrotic and viable myocardium at the periphery of myocardial infarction (MI), has been noted to be a modulator of cardiac outcomes. Most studies have not reported a direct correlation between infarct core and the zone of heterogeneity. Furthermore, no large population based studies have examined the burden of undiagnosed infarct and infarct heterogeneity.
Methods
We report the data from 215 individuals (of the total 950 enrolled in the Iceland MI study) who were found to have myocardial infarction by late gadolinium enhancement on CMR. The infarct core and gray zone assessment was performed by FWHM and 2SD threshold, respectively.
Results
The median infarct core, as a percentage of left ventricular mass was 6.3% (5.4-6.9, 95% CI) and the gray zone was 4.5% (3.8-5.2, 95% CI). The correlation between gray zone and infarct core assessed by Spearman's rank coefficient (rho) was 0.88 (0.80-0.90) P < 0.0001. When gray zone was normalized to total scar size, it had a negative correlation with infarct core, rho of -0.53 (-0.62--0.42), P < 0.0001. Furthermore, non-linear regression with a simple power function fit the relationship between gray zone and infarct size (R2 = 0.74).
Conclusions
These data suggest that gray zone correlates strongly to infarct core size but the relationship is best explained by a nonlinear regression model. Gray zone constitutes a larger portion of total scar in smaller infarcts. Further analysis of clinical outcomes will shed light on the differential prognostic information provided by these CMR parameters.
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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.
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Mehra, V.C., Hsu, LY., Miller, C. et al. The relationship of gray zone and infarct core in the Iceland MI study. J Cardiovasc Magn Reson 18 (Suppl 1), P99 (2016). https://doi.org/10.1186/1532-429X-18-S1-P99
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DOI: https://doi.org/10.1186/1532-429X-18-S1-P99
Keywords
- Myocardial Infarction
- Late Gadolinium Enhancement
- Left Ventricular Mass
- Viable Myocardium
- Gray Zone