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Evaluation of myocardial viability in myocardial infarction patients by magnetic resonance perfusion and delayed enhancement imaging

Untersuchung der Myokardvitalität bei Patienten mit Myokardinfarkt mittels Perfusions- und Delayed-enhancement-Magnetresonanztomographie

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Abstract

Objective

Cardiovascular magnetic resonance imaging (CMR) has been established as a modality to detect myocardial viability. The aim of this study was to evaluate myocardial viability by observing transmural extent of infraction and microvascular perfusion level.

Methods

We performed CMR in 30 myocardial infarction (MI) patients within 7–10 days. At the 6‑month follow-up, CMR was used to evaluate the impact of abnormal reperfusion and observe the transmural extent of infraction on recovery of function.

Results

The left ventricle was divided into 16 segments using the American Heart Association classification. Infarcts were detected in 202 of the 480 segments (42%) by delayed enhancement magnetic resonance imaging (DE-MRI). According to first-pass myocardial perfusion, abnormal perfusion was detected in 278 of 480 segments (60%), reduced perfusion was identified in 173 of 278 (62%), and perfusion defects in 105 of 278 segments (38%). The results showed that the segments with abnormal perfusion were larger than in DE-MRI (P < 0.05), indicating that the area of abnormal perfusion segments extend significantly beyond the region of infarction. Microvascular perfusion with an infarcted region was lower compared to non-infarcted segments (P < 0.05). The extent of myocardial hyperenhancement correlated inversely with microvascular perfusion (P < 0.05). Segments with severe microvascular perfusion and >75% transmural infarction on the 7‑ to 10-day scan had markedly increased at the 6‑month follow-up (P < 0.01), indicating a lack of recovery of cardiac function.

Conclusions

DE-MRI combined with microvascular perfusion may be effective to detect viable myocardium in patients with MI and may provide a means of predicting whether revascularization will be effective.

Zusammenfassung

Ziel

Die kardiovaskuläre Magnetresonanztomographie (CMR) ist als Verfahren zur Untersuchung der Myokardvitalität etabliert. Ziel der vorliegenden Studie war es, die Myokardvitalität durch Betrachtung der transmuralen Infarktausdehnung und des mikrovaskulären Perfusionsgrads einzuschätzen.

Methoden

Bei 30 Patienten mit Myokardinfarkt (MI) wurde innerhalb von 7 bis 10 Tagen eine CMR durchgeführt. Im 6‑Monats-Follow-up wurden mithilfe der CMR die Auswirkungen einer abnormen Reperfusion und der festgestellten transmuralen Infarktausdehnung auf die funktionelle Wiederherstellung eingeschätzt.

Ergebnisse

Der linke Ventrikel wurde anhand der Klassifikation der American Heart Association in 16 Abschnitte unterteilt. Infarkte wurden mithilfe der Delayed-enhancement-Magnetresonanztomographie (DE-MRT) in 202 von 480 Abschnitten (42 %) festgestellt. Bezüglich der First-Pass-Myokardperfusion fand sich in 278 von 480 Abschnitten (60 %) eine abnorme Perfusion. Eine verringerte Perfusion wurde in 173 von 278 Abschnitten (62 %) festgestellt, Perfusionsdefekte in 105 von 278 (38 %). Gemäß diesen Ergebnissen waren die Abschnitte mit abnormer Perfusion größer als in der DE-MRT (P < 0,05), was darauf hindeutet, dass der Bereich abnorm perfundierter Abschnitte sich erheblich über die Infarktregion hinaus erstreckt. Die mikrovaskuläre Perfusion war in der Infarktregion geringer als in nichtinfarzierten Abschnitten (P < 0,05). Die Ausdehnung des myokardialen „hyperenhancement“ korrelierte invers mit der mikrovaskulären Perfusion (P < 0,05). Abschnitte mit schwer beeinträchtigter mikrovaskulärer Perfusion und >75 %iger transmuraler Infarzierung in der Untersuchung nach 7–10 Tagen nahmen bis zum 6‑Monats-Follow-up deutlich zu (P < 0,01), was mit einer ausbleibenden Wiederherstellung der Herzfunktion assoziiert ist.

Schlussfolgerungen

Die DE-MRT in Kombination mit der mikrovaskulären Perfusion könnte die Möglichkeit bieten, vitales Myokard bei Patienten mit MI zu identifizieren. Weiterhin könnte sie der Prognose dienen, ob eine Revaskularisierung erfolgreich sein wird.

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Acknowledgments

We thank Xinxiang Zhao for her generous help with our manuscript.

Funding

This work was supported by the grants from the National Natural Science Foundation of China (No. 8126023) and the Program for Innovative Rescarch Team (in Science and Technology) in University of Yunnan Province.

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Authors and Affiliations

  1. Department of Cardiology, Second Affiliated Hospital of Kunming Medical University, 374 Dianmian road, Wuhua Area, 650101, Kunming, China

    W. Sun MD, L. Sun PhD & F. Yang MD

  2. Department of Radiology, Second Affiliated Hospital of Kunming Medical University, 650101, Kunming, China

    X. Zhao PhD & R. Cai MD

  3. Department of Radiology, First Affiliated Hospital of Chengdu Medical College, 610500, Chengdu, China

    W. Yuan MD

Authors
  1. W. Sun MD
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  2. L. Sun PhD
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  3. F. Yang MD
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  5. R. Cai MD
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Corresponding author

Correspondence to L. Sun PhD.

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Conflict of interest

W. Sun, L. Sun, F. Yang, X. Zhao, R. Cai, and W. Yuan declare that they have no competing interests.

Our subjects provided informed consent and the study protocol was approved by the institute’s committee on human research.

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Sun, W., Sun, L., Yang, F. et al. Evaluation of myocardial viability in myocardial infarction patients by magnetic resonance perfusion and delayed enhancement imaging. Herz 44, 735–742 (2019). https://doi.org/10.1007/s00059-018-4741-z

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  • DOI: https://doi.org/10.1007/s00059-018-4741-z

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