Advertisement

European Radiology

, Volume 29, Issue 2, pp 951–962 | Cite as

BOLD cardiac MRI for differentiating reversible and irreversible myocardial damage in ST segment elevation myocardial infarction

  • Bing-Hua Chen
  • Ruo-Yang Shi
  • Dong-Aolei An
  • Rui Wu
  • Chong-Wen Wu
  • Jiani Hu
  • Amanda Manly
  • Hisham Kaddurah
  • Jie He
  • Jun Pu
  • Jian-Rong XuEmail author
  • Lian-Ming WuEmail author
Cardiac

Abstract

Objectives

BOLD imaging is a quantitative MRI technique allowing the evaluation of the balance between supply/demand in myocardial oxygenation and myocardial haemorrhage. We sought to investigate the ability of BOLD imaging to differentiate reversible from irreversible myocardial injury as well as the chronological progression of myocardial oxygenation after reperfusion in patients with ST segment elevation myocardial infarction (STEMI).

Methods

Twenty-two patients (age, 60 ± 11 years; 77.3% male) with STEMI underwent cardiac MRIs on four occasions: on days 1, 3, 7 and 30 after reperfusion. BOLD MRI was obtained with a multi-echo turbo field echo (TFE) sequence on a 3-T scanner to assess myocardial oxygenation in MI.

Results

T2* value in MI with intramyocardial haemorrhage (IMH) was the lowest (9.77 ± 3.29 ms), while that of the salvaged zone was the highest (33.97 ± 3.42 ms). T2* values in salvaged myocardium demonstrated a unimodal temporal pattern from days 1 (37.91 ± 2.23 ms) to 30 (30.68 ± 1.59 ms). T2* values in the MI regions were significantly lower than those in remote myocardium, although the trends in both were constant overall. There was a slightly positive correlation between T2* in MI regions and EF (Rho = 0.27, p < 0.05) or SV (Rho = 0.22, p = 0.04) and a slightly negative correlation between T2* in salvaged myocardium and LVEDV (Rho = – 0.23, p < 0.05).

Conclusions

BOLD MRI performed in post-STEMI patients allows accurate evaluation of myocardial damage severity and could differentiate reversible from irreversible myocardial injury. The increased T2* values may imply the pathophysiological mechanism of salvaged myocardium. BOLD MRI could represent a more accurate alternative to the other currently available options.

Key Points

• Myocardial oxygenation and haemorrhage after myocardial infarction affect BOLD MRI values

• BOLD MRI could be used to differentiate irreversible from reversible myocardial damage

• Changed oxygenation implies the pathophysiological mechanism of salvaged myocardium

Keywords

Magnetic resonance imaging ST elevation myocardial infarction Reperfusion Myocardium Haemoglobins 

Abbreviations

BOLD

Blood oxygen level-dependent

FWHM

Full width at half maximum

IMH

Intramyocardial haemorrhage

LGE

Late gadolinium enhancement

MI

Myocardial infarction

MRI

Magnetic resonance imaging

MVO

Microvascular obstruction

PCI

Percutaneous coronary intervention

ROI

Region of interest

SSFP

Steady-state free precession

STEMI

ST segment elevation myocardial infarction

T2W-STIR

T2-weighted short-tau triple inversion recovery

Notes

Funding

Shanghai Municipal Commission of Health and Family Planning excellent young talent program (No. 2017YQ031), Renji Hospital Clinical Training Fund (PYEY16-001), Shanghai talent development fund (201559), Shanghai young doctor training program, Shanghai Jiao Tong University “Chen-Xing B” program.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Lian-Ming Wu.

Conflict of interest

The authors state that there neither exists a conflict of interest nor that there is financial information to disclose.

Statistics and biometry

Lian-Ming Wu kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was obtained from all participants in this study.

Ethical approval

Institutional review board approval was obtained.

Methodology

• prospective

• observational

• single-centre study

References

  1. 1.
    Reimer KA, Jennings RB (1979) The “wavefront phenomenon” of myocardial ischemic cell death. II. Transmural progression of necrosis within the framework of ischemic bed size (myocardium at risk) and collateral flow. Lab Invest 6:633–644Google Scholar
  2. 2.
    Friedrich MG, Abdel-Aty H, Taylor A et al (2008) The salvaged area at risk in reperfused acute myocardial infarction as visualized by cardiovascular magnetic resonance. J Am Coll Cardiol 16:1581–1587Google Scholar
  3. 3.
    Nordmann AJ, Hengstler P, Harr T et al (2004) Clinical outcomes of primary stenting versus balloon angioplasty in patients with myocardial infarction: a meta-analysis of randomized controlled trials. Am J Med 4:253–262CrossRefGoogle Scholar
  4. 4.
    Heusch P, Nensa F, Heusch G (2015) Is MRI really the gold standard for the quantification of salvage from myocardial infarction? Circ Res 3:222–224CrossRefGoogle Scholar
  5. 5.
    Eitel I, Desch S, Fuernau G et al (2010) Prognostic significance and determinants of myocardial salvage assessed by cardiovascular magnetic resonance in acute reperfused myocardial infarction. J Am Coll Cardiol 22:2470–2479CrossRefGoogle Scholar
  6. 6.
    Payne AR, Casey M, McClure J et al (2011) Bright-blood T2-weighted MRI has higher diagnostic accuracy than dark-blood short tau inversion recovery MRI for detection of acute myocardial infarction and for assessment of the ischemic area at risk and myocardial salvage. Circ Cardiovasc Imaging 3:210–219CrossRefGoogle Scholar
  7. 7.
    Hammer-Hansen S, Ugander M, Hsu LY et al (2014) Distinction of salvaged and infarcted myocardium within the ischaemic area-at-risk with T2 mapping. Eur Heart J Cardiovasc Imaging 9:1048–1053CrossRefGoogle Scholar
  8. 8.
    Liu D, Borlotti A, Viliani D et al (2017) CMR native T1 mapping allows differentiation of reversible versus irreversible myocardial damage in ST-segment-elevation myocardial infarction: an OxAMI study (Oxford acute myocardial infarction). Circ Cardiovasc Imaging.  https://doi.org/10.1161/CIRCIMAGING.116.005986
  9. 9.
    Bauer WR, Nadler W, Bock M et al (1999) The relationship between the BOLD-induced T(2) and T(2)(*): a theoretical approach for the vasculature of myocardium. Magn Reson Med 6:1004–1010CrossRefGoogle Scholar
  10. 10.
    O’Regan DP, Ariff B, Neuwirth C et al (2010) Assessment of severe reperfusion injury with T2* cardiac MRI in patients with acute myocardial infarction. Heart 23:1885–1891CrossRefGoogle Scholar
  11. 11.
    Carrick D, Haig C, Ahmed N et al (2016) Temporal evolution of myocardial hemorrhage and edema in patients after acute ST-segment elevation myocardial infarction: pathophysiological insights and clinical implications. J Am Heart Assoc.  https://doi.org/10.1161/JAHA.115.002834
  12. 12.
    Fallavollita JA, Malm BJ, Canty JM Jr (2003) Hibernating myocardium retains metabolic and contractile reserve despite regional reductions in flow, function, and oxygen consumption at rest. Circ Res 1:48–55CrossRefGoogle Scholar
  13. 13.
    Levine GN, Bates ER, Bittl JA et al (2016) 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: an update of the 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention, 2011 ACCF/AHA guideline for coronary artery bypass graft surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease, 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction, 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes, and 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery. Circulation 10:e123-55Google Scholar
  14. 14.
    Huelnhagen T, Hezel F, Serradas Duarte T et al (2017) Myocardial effective transverse relaxation time T2* correlates with left ventricular wall thickness: a 7.0 T MRI study. Magn Reson Med 6:2381–2389CrossRefGoogle Scholar
  15. 15.
    Khan JN, Nazir SA, Horsfield MA et al (2015) Comparison of semi-automated methods to quantify infarct size and area at risk by cardiovascular magnetic resonance imaging at 1.5T and 3.0T field strengths. BMC Res Notes 8:52CrossRefGoogle Scholar
  16. 16.
    Mikami Y, Kolman L, Joncas SX et al (2014) Accuracy and reproducibility of semi-automated late gadolinium enhancement quantification techniques in patients with hypertrophic cardiomyopathy. J Cardiovasc Magn Reson 16:85CrossRefGoogle Scholar
  17. 17.
    Robbers LF, Eerenberg ES, Teunissen PF et al (2013) Magnetic resonance imaging-defined areas of microvascular obstruction after acute myocardial infarction represent microvascular destruction and haemorrhage. Eur Heart J 30:2346–2353CrossRefGoogle Scholar
  18. 18.
    Brooks RA, Di Chiro G (1987) Magnetic resonance imaging of stationary blood: a review. Med Phys 6:903–913CrossRefGoogle Scholar
  19. 19.
    Ghugre NR, Ramanan V, Pop M et al (2011) Myocardial BOLD imaging at 3 T using quantitative T2: application in a myocardial infarct model. Magn Reson Med 6:1739–1747CrossRefGoogle Scholar
  20. 20.
    Wacker C, Hartlep A, Pfleger S et al (2003) Susceptibility-sensitive magnetic resonance imaging detects human myocardium supplied by a stenotic coronary artery without a contrast agent. J Am Coll Cardiol 5:834–840CrossRefGoogle Scholar
  21. 21.
    Atalay MK, Poncelet BP, Kantor HL et al (2001) Cardiac susceptibility artifacts arising from the heart-lung interface. Magn Reson Med 2:341–345CrossRefGoogle Scholar
  22. 22.
    Reeder SB, Faranesh AZ, Boxerman JL et al (1998) In vivo measurement of T*2 and field inhomogeneity maps in the human heart at 1.5 T. Magn Reson Med 6:988–998CrossRefGoogle Scholar
  23. 23.
    O'Regan DP, Ahmed R, Neuwirth C et al (2009) Cardiac MRI of myocardial salvage at the peri-infarct border zones after primary coronary intervention. Am J Physiol Heart Circ Physiol 1:H340–H346CrossRefGoogle Scholar
  24. 24.
    Garcia-Dorado D, Oliveras J (1993) Myocardial oedema: a preventable cause of reperfusion injury? Cardiovasc Res 9:1555–1563CrossRefGoogle Scholar
  25. 25.
    Atkinson DJ, Burstein D, Edelman RR (1990) First-pass cardiac perfusion: evaluation with ultrafast MR imaging. Radiology 3:757–762CrossRefGoogle Scholar
  26. 26.
    Weng AM, Ritter CO, Lotz J et al (2010) Automatic postprocessing for the assessment of quantitative human myocardial perfusion using MRI. Eur Radiol 6:1356–1365CrossRefGoogle Scholar
  27. 27.
    de Jong MC, Genders TS, van Geuns RJ et al (2012) Diagnostic performance of stress myocardial perfusion imaging for coronary artery disease: a systematic review and meta-analysis. Eur Radiol 9:1881–1895CrossRefGoogle Scholar
  28. 28.
    Utz W, Niendorf T, Wassmuth R et al (2007) Contrast-dose relation in first-pass myocardial MR perfusion imaging. J Magn Reson Imaging 6:1131–1135CrossRefGoogle Scholar
  29. 29.
    Karamitsos TD, Leccisotti L, Arnold JR et al (2010) Relationship between regional myocardial oxygenation and perfusion in patients with coronary artery disease: insights from cardiovascular magnetic resonance and positron emission tomography. Circ Cardiovasc Imaging 1:32–40CrossRefGoogle Scholar
  30. 30.
    McCommis KS, Goldstein TA, Abendschein DR et al (2010) Quantification of regional myocardial oxygenation by magnetic resonance imaging: validation with positron emission tomography. Circ Cardiovasc Imaging 1:41–46CrossRefGoogle Scholar
  31. 31.
    Lotan CS, Bouchard A, Cranney GB et al (1992) Assessment of postreperfusion myocardial hemorrhage using proton NMR imaging at 1.5 T. Circulation 3:1018–1025CrossRefGoogle Scholar
  32. 32.
    Wu KC, Zerhouni EA, Judd RM et al (1998) Prognostic significance of microvascular obstruction by magnetic resonance imaging in patients with acute myocardial infarction. Circulation 8:765–772CrossRefGoogle Scholar
  33. 33.
    Robbers L, Nijveldt R, Beek AM et al (2018) The influence of microvascular injury on native T1 and T2* relaxation values after acute myocardial infarction: implications for non-contrast-enhanced infarct assessment. Eur Radiol 28:824–832CrossRefGoogle Scholar
  34. 34.
    Manka R, Paetsch I, Schnackenburg B et al (2010) BOLD cardiovascular magnetic resonance at 3.0 tesla in myocardial ischemia. J Cardiovasc Magn Reson 12:54CrossRefGoogle Scholar
  35. 35.
    Cuculi F, Dall'Armellina E, Manlhiot C et al (2014) Early change in invasive measures of microvascular function can predict myocardial recovery following PCI for ST-elevation myocardial infarction. Eur Heart J 29:1971–1980CrossRefGoogle Scholar
  36. 36.
    Kloner RA, Ganote CE, Jennings RB (1974) The "no-reflow" phenomenon after temporary coronary occlusion in the dog. J Clin Investig 6:1496–1508CrossRefGoogle Scholar
  37. 37.
    Ambrosio G, Weisman HF, Mannisi JA et al (1989) Progressive impairment of regional myocardial perfusion after initial restoration of postischemic blood flow. Circulation 6:1846–1861CrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Bing-Hua Chen
    • 1
  • Ruo-Yang Shi
    • 1
  • Dong-Aolei An
    • 1
  • Rui Wu
    • 1
  • Chong-Wen Wu
    • 1
  • Jiani Hu
    • 2
  • Amanda Manly
    • 2
  • Hisham Kaddurah
    • 2
  • Jie He
    • 3
  • Jun Pu
    • 3
  • Jian-Rong Xu
    • 1
    Email author
  • Lian-Ming Wu
    • 1
    Email author
  1. 1.Department of RadiologyRenji Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghaiPeople’s Republic of China
  2. 2.Department of RadiologyWayne State UniversityDetroitUSA
  3. 3.Department of CardiologyRenji Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghaiPeople’s Republic of China

Personalised recommendations