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Myocardial perfusion assessment in the infarct core and penumbra zones in an in-vivo porcine model of the acute, sub-acute, and chronic infarction

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Abstract

Objectives

To assess the longitudinal changes of microvascular function in different myocardial regions after myocardial infarction (MI) using myocardial blood flow derived by dynamic CT perfusion (CTP-MBF), and compare CTP-MBF with the results of cardiac magnetic resonance (CMR) and histopathology.

Methods

The CTP scanning was performed in a MI porcine model 1 day (n = 15), 7 days (n = 10), and 3 months (n = 5) following induction surgery. CTP-MBF was measured in the infarcted myocardium, penumbra, and remote myocardium, respectively. CMR perfusion and histopathology were performed for validation.

Results

From baseline to follow-up scans, CTP-MBF presented a stepwise increase in the infarcted myocardium (68.51 ± 11.04 vs. 86.73 ± 13.32 vs. 109.53 ± 26.64 ml/100 ml/min, p = 0.001) and the penumbra (104.92 ± 29.29 vs. 120.32 ± 24.74 vs. 183.01 ± 57.98 ml/100 ml/min, p = 0.008), but not in the remote myocardium (150.05 ± 35.70 vs. 166.66 ± 38.17 vs. 195.36 ± 49.64 ml/100 ml/min, p = 0.120). The CTP-MBF correlated with max slope (r = 0.584, p < 0.001), max signal intensity (r = 0.357, p < 0.001), and time to max (r = − 0.378, p < 0.001) by CMR perfusion. Moreover, CTP-MBF defined the infarcted myocardium on triphenyl tetrazolium chloride staining (AUC: 0.810, p < 0.001) and correlated with microvascular density on CD31 staining (r = 0.561, p = 0.002).

Conclusion

CTP-MBF could quantify the longitudinal changes of microvascular function in different regions of the post-MI myocardium, which demonstrates good agreement with contemporary CMR and histopathological findings.

Key Points

• The CT perfusion–based myocardial blood flow (CTP-MBF) could quantify the microvascular impairment in different myocardial regions after myocardial infarction (MI) and track its recovery over time.

• The assessment of CTP-MBF is in good agreement with contemporary cardiac MRI and histopathological findings, which potentially facilitates a rapid approach for pathophysiological insights following MI.

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Abbreviations

CAD:

Coronary artery disease

CMR:

Cardiac magnetic resonance

CTA:

CT angiography

CTP:

CT perfusion

H&E:

Hematoxylin-eosin

LGE:

Late gadolinium enhancement

MBF:

Myocardial blood flow

MI:

Myocardial infarction

ROI:

Region of interest

SI:

Signal intensity

SPECT:

Single-photon emission computed tomography

TTC:

Triphenyl tetrazolium chloride

TTM:

Time to maximum signal intensity

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Funding

This work was supported by the National Natural Science Foundation of China (81471721, 81471722, 81641169, 81771887, 81771897, 81901712, and 81971586); the Program for New Century Excellent Talents in University (No. NCET-13-0386); the Program for Young Scholars and Innovative Research Team in Sichuan Province (No. 2017TD0005) of China; the Applied and Fundamental Study of Sichuan Province (No. 2017JY0026); and 1·3·5 project for disciplines of excellence, West China Hospital, Sichuan University (No. ZYGD18013).

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Author notes

  1. Meng-xi Yang and Hua-yan Xu contributed equally to this work and should be considered as the equal first authors.

Authors and Affiliations

  1. Department of Radiology, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China

    Meng-xi Yang & Zhi-gang Yang

  2. Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, China

    Hua-yan Xu, Lu Zhang, Lin Chen, Rong Xu, Hang Fu, Hui Liu & Ying-kun Guo

  3. Department of Radiology, West China Second Hospital, Sichuan University, Chengdu, China

    Xue-sheng Li & Chuan Fu

  4. Department of Radiology, West China Hospital, Sichuan University, Chengdu, China

    Ke-ling Liu & Zhi-gang Yang

  5. Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, China

    Hong Li

  6. MR Collaboration, Siemens Healthcare Ltd, Shanghai, China

    Xiao-yue Zhou

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  1. Meng-xi Yang
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Correspondence to Zhi-gang Yang.

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The scientific guarantor of this publication is Zhi-gang Yang.

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One of the authors of this manuscript (Xiao-yue Zhou) is an employee of Siemens Healthcare. The remaining authors declare no relationships with any companies whose products or services may be related to the subject matter of the article.

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Yang, Mx., Xu, Hy., Zhang, L. et al. Myocardial perfusion assessment in the infarct core and penumbra zones in an in-vivo porcine model of the acute, sub-acute, and chronic infarction. Eur Radiol 31, 2798–2808 (2021). https://doi.org/10.1007/s00330-020-07220-x

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