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Myocardial Salvage Imaging: Where Are We and Where Are We Heading? A Cardiac Magnetic Resonance Perspective

  • Cardiac Magnetic Resonance (E Nagel and V Puntmann, Section Editors)
  • Published:
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Abstract

Purpose of Review

Cardiac magnetic resonance (CMR) has emerged in recent years as a reliable tool to assess, in a single examination after a reperfused myocardial infarction, the initially area at risk (AAR), the final infarct size (IS), and from their difference the salvaged myocardium (SM). The aim of the present review is to summarize recent advances in the CMR imaging of SM.

Recent Findings

While there is consensus on the use of late gadolinium enhancement (LGE) to calculate IS, how to assess the AAR is a debated topic. The use of T2-weighted short-TI inversion recovery (T2W-STIR) is to date supported by a large amount of data, but it is affected by several limitations. Newer techniques have been developed to overcome T2W-STIR limitations, some of them have been already used in randomized clinical trials (RCTs) while others are showing promising results. The use of CMR to generate surrogate endpoints in RCTs is gaining attention; in this context, analysis of data from recent RCTs suggests that the assessment of SM as outcome measure could be useful to reduce sample sizes and costs of trials.

Summary

CMR is a reliable technique for the assessment of SM. LGE is the gold standard for IS measurement, while which is the best technique for the evaluation of AAR is still debated. When using CMR-derived endpoints in RCTs, the assessment of SM is advisable.

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Authors and Affiliations

  1. Department of Cardiology, S. Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa 1035/1039, 00189, Rome, Italy

    Luca Arcari

  2. Bristol Heart Institute, and Bristol National Institute of Health Research (NIHR) Biomedical Research Centre (BRC), University Hospitals Bristol NHS Trust and University of Bristol, Bristol, UK

    Chiara Bucciarelli-Ducci

  3. Department of Radiology, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy

    Marco Francone

  4. Department of Cardiology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy

    Luciano Agati

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Chiara Bucciarelli-Ducci reports personal fees from Circle Cardiovascular Imaging, outside of the submitted work.

Marco Francone reports personal fees from Bracco Speaker Bureau, outside of the submitted work.

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Arcari, L., Bucciarelli-Ducci, C., Francone, M. et al. Myocardial Salvage Imaging: Where Are We and Where Are We Heading? A Cardiac Magnetic Resonance Perspective. Curr Cardiovasc Imaging Rep 11, 8 (2018). https://doi.org/10.1007/s12410-018-9448-2

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