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Quantitation of the thickness of the non-enhanced myocardial rim predicts recovery of territorial myocardial function in chronic ischemic heart disease: a cardiac magnetic resonance imaging study

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Abstract

Objectives

We sought to determine whether the thickness of the non-contrast-enhanced myocardial rim (RIM) predicts recovery of territorial myocardial function after revascularization in chronic ischemic cardiomyopathy (ICM).

Background

Non-contrast-enhanced dysfunctional myocardium at late gadolinium-enhanced CMR depicts the presence of viable myocardium.

Methods

In 29 patients (65 ± 8 years) with ICM (EF 33 ± 10), ceCMR and cine images were acquired 5 ± 10 days before revascularization. Cine images were repeated after 6 months. Regional wall thickness, wall thickening and RIM were determined in each of 12 segments per short-axis slice (4–8/patient), which were assigned to the respective supplying coronary artery (LAD, LCX and RCA). A threshold for normal wall-thickening was derived from a control group (n = 14; 52 ± 17 years). Functional improvement at follow-up was defined as wall thickening >2 mm.

Results

Of the 1,896 analyzed segments, 655 segments showed severe dysfunction. At follow-up, 307 segments demonstrated functional improvement. The RIM differed between segments with and without improvement (6.6 ± 2.4 mm vs. 2.8 ± 2.0 mm; p < 0.0001). The area under the receiver operator characteristic (ROC) for predicting overall functional recovery was 0.91 (95%, CI 0.88–0.93, p < 0.001). A RIM of 4.0 mm predicted functional recovery after revascularization of the supplying coronary artery with a sensitivity and a specificity of 88 and 82% for the LAD, 96 and 86% for the RCA and 88 and 83% for the LCX, respectively.

Conclusion

RIM may be a useful marker for predicting territorial functional recovery after revascularization in patients with chronic ICM.

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Acknowledgments

This research project is being supported by the “Interdisciplinary Center for Clinical Research on Biomaterials and Tissue-Material-Interaction in Implants” (to HPK) and by the DFG (TR is a Heisenberg scholar of the DFG, RA 969/5-1).

Conflict of interest statement

None.

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Author notes

  1. Tienush Rassaf & Malte Kelm

    Present address: Division of Cardiology, Pulmonology and Vascular Diseases, Department of Medicine, University Hospital Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany

  2. Harald P. Kühl

    Present address: Division of Cardiology, Department of Medicine, Städtisches Klinikum München GmbH, Klinikum Harlaching, Sanatoriumsplatz 2, 81545, Munich, Germany

Authors and Affiliations

  1. Division of Cardiology, Pulmonology and Vascular Diseases, Department of Medicine, University Hospital Aachen, Aachen, Germany

    Tienush Rassaf, Johannes Nolte, Malte Kelm & Harald P. Kühl

  2. Department of Medical Statistics, Aachen, Germany

    Nicole Heussen

  3. Clinic for Radiological Diagnostics, Pauwelsstr. 30, 52074, Aachen, Germany

    Gaby A. Krombach & Rolf W. Günther

Authors
  1. Tienush Rassaf
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  2. Johannes Nolte
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  3. Nicole Heussen
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Corresponding author

Correspondence to Harald P. Kühl.

Additional information

T. Rassaf, J. Nolte, and H. P. Kühl contributed equally to this work.

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Rassaf, T., Nolte, J., Heussen, N. et al. Quantitation of the thickness of the non-enhanced myocardial rim predicts recovery of territorial myocardial function in chronic ischemic heart disease: a cardiac magnetic resonance imaging study. Clin Res Cardiol 99, 293–300 (2010). https://doi.org/10.1007/s00392-010-0117-y

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  • DOI: https://doi.org/10.1007/s00392-010-0117-y

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