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Validation of contrast enhanced cine steady-state free precession and T2-weighted CMR for assessment of ischemic myocardial area-at-risk in the presence of reperfusion injury

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Abstract

The purpose of the study was to validate by histopathology, contrast enhanced cine steady-state free precession and T2-weighted CMR for the assessment of ischemic myocardial area-at-risk (AAR) in the presence of microvascular obstruction (MVO). Eleven anesthetized pigs underwent CMR 7 to 10 days post infarction. The area-at-risk was measured from T2-weighted fast spin echo (T2-STIR) and contrast-enhanced steady-state free precession magnetic resonance imaging (CE-SSFP) images using semi-automated algorithms based on a priori knowledge of perfusion territory. Also, late gadolinium enhancement (LGE) was performed to measure final infarct size (FIS). Histopathological comparison with Evans blue dye to define AAR and triphenyltetrazolium chloride to define FIS served as the reference. All infarcts demonstrated MVO on LGE images. Bland–Altman analysis showed no significant bias in AAR or myocardial salvage between T2-STIR and CE-SSFP or between CMR and histopathology. The mean differences ± 2SD from Bland–Altman analysis were: AAR: Evans Blue vs. T2-STIR [0.7%; + 13.5%; − 12.1%]; AAR: Evans Blue vs. CE-SSFP [0.1%; + 13.8%; − 13.7%]; AAR: T2-STIR vs. CE-SSFP [0.7%; + 6.2%; − 4.9%]; Salvage: Evans Blue − TTC vs. T2-STIR-LGE [0.8%; + 11.1%; − 9.6%]; Salvage: Evans Blue − TTC vs. CE-SSFP-LGE [0.1%; + 9.9%; − 9.6%]; Salvage: CE-SSFP-LGE vs. T2-STIR-LGE [0.7%; + 6.2%; − 4.9%]. Both T2-STIR and CE-SSFP sequences allow for unbiased quantification of AAR in the presence of ischemia/reperfusion injury when analysed by semi-automated algorithms. These experimental data, which was validated by histopathology, supports the use of CMR for the assessment of myocardial salvage during the subacute phase.

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Abbreviations

AAR:

Area-at-risk

FIS:

Final infarct size

CMR:

Cardiovascular magnetic resonance

CE-SSFP:

Contrast-enhanced steady-state free precession magnetic resonance imaging

ECG:

Electrocardiogram

LV:

Left ventricular

B-SSFP:

Balanced-steady-state-free-precession

FOV:

Field of view

TR:

Repetition time

TE:

Echo time

LGE:

Late gadolinium enhancement

MVO:

Microvascular obstruction

TTC:

Triphenyltetrazolium chloride

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Acknowledgements

Funded by The Danish Diabetes Academy and supported by the Novo Nordisk Foundation (NNF17OC0028766) and The Health Research Fund of Central Denmark Region, Denmark.

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Authors and Affiliations

  1. The MR Research Centre and Department of Clinical Medicine, Aarhus University Hospital Skejby, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark

    Esben Søvsø Szocska Hansen & Won Yong Kim

  2. Danish Diabetes Academy, Odense, Denmark

    Esben Søvsø Szocska Hansen

  3. Department of Cardiothoracic and Vascular Surgery T, Aarhus University Hospital Skejby, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark

    Steen Fjord Pedersen

  4. Department of Endocrinology and Internal Medicine, Aarhus University Hospital THG, Tage-Hansens Gade 2, 8000, Aarhus C, Denmark

    Steen Bønløkke Pedersen

  5. Department of Cardiology, Aarhus University Hospital Skejby, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark

    Hans Erik Bøtker & Won Yong Kim

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  1. Esben Søvsø Szocska Hansen
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Correspondence to Won Yong Kim.

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Hansen, E.S.S., Pedersen, S.F., Pedersen, S.B. et al. Validation of contrast enhanced cine steady-state free precession and T2-weighted CMR for assessment of ischemic myocardial area-at-risk in the presence of reperfusion injury. Int J Cardiovasc Imaging 35, 1039–1045 (2019). https://doi.org/10.1007/s10554-019-01569-x

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  • DOI: https://doi.org/10.1007/s10554-019-01569-x

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