Contrast-Enhanced CMR Overestimates Early Myocardial Infarct Size: Mechanistic Insights Using ECV Measurements on Day 1 and Day 7.

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  • Additional Information
    • Source:
      Publisher: Elsevier Country of Publication: United States NLM ID: 101467978 Publication Model: Print Cited Medium: Internet ISSN: 1876-7591 (Electronic) Linking ISSN: 18767591 NLM ISO Abbreviation: JACC Cardiovasc Imaging Subsets: MEDLINE
    • Publication Information:
      Original Publication: New York : Elsevier
    • Subject Terms:
      Gadolinium DTPA* ; Tetrazolium Salts*; Magnetic Resonance Imaging, Cine/*methods ; Myocardial Infarction/*pathology ; Radiographic Image Enhancement/*methods; Acute Disease ; Animals ; Chronic Disease ; Contrast Media ; Disease Models, Animal ; Male ; Myocardial Infarction/diagnosis ; Predictive Value of Tests ; Random Allocation ; Risk Assessment ; Sensitivity and Specificity ; Swine ; Time Factors
    • Abstract:
      Objectives: This study aimed to investigate whether an overestimation of infarct size on cardiac magnetic resonance (CMR) versus triphenyltetrazolium chloride (TTC) exists acutely and whether it remains after 7 days in an experimental pig model and to elucidate possible mechanisms.
      Background: Overestimation of infarct size (IS) on late gadolinium enhancement CMR early after acute myocardial infarction has been debated.
      Methods: Pigs were subjected to 40 min of left anterior descending artery occlusion and 6 h (n = 9) or 7 days (n = 9) reperfusion. IS by in vivo and ex vivo CMR was compared with TTC staining. Extracellular volume (ECV) was obtained from biopsies using technetium 99m diethylenetriamine pentaacetic acid (99mTc-DTPA) and light microscopy. TTC slices were rescanned on CMR enabling slice-by-slice comparison.
      Results: IS did not differ between in vivo and ex vivo CMR (p = 0.77). IS was overestimated by 27.3% with ex vivo CMR compared with TTC (p = 0.008) acutely with no significant difference at 7 days (p = 0.39). Slice-by-slice comparison showed similar results. A significant decrease in ECV was seen in biopsies of myocardium at risk (MaR) close to the infarct (sometimes referred to as the peri-infarction zone) over 7 days (48.3 ± 4.4% vs. 29.2 ± 2.4%; p = 0.0025). The ECV differed between biopsies of MaR close to the infarct and the rest of the salvaged MaR acutely (48.3 ± 4.4% vs. 32.4 ± 3.2%; p = 0.013) but not at 7 days (29.2 ± 2.4% vs 25.7 ± 1.4%; p = 0.23).
      Conclusions: CMR overestimates IS compared with TTC acutely but not at 7 days. This difference may be explained by higher ECV in MaR closest to the infarct acutely that decreases during 7 days to the same level as the rest of the salvaged MaR. The increased ECV in the MaR closest to the infarct day 1 could be due to severe edema or an admixture of infarcted and salvaged myocardium (partial volume) or both. Nonetheless, this could not be reproduced at 7 days. These results have implications for timing of magnetic resonance infarct imaging early after acute myocardial infarction.
      (Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
    • Comments:
      Comment in: JACC Cardiovasc Imaging. 2015 Dec;8(12):1390-2. (PMID: 26699108)
      Comment in: JACC Cardiovasc Imaging. 2016 Aug;9(8):1016-7. (PMID: 27236521)
      Comment in: JACC Cardiovasc Imaging. 2016 Aug;9(8):1015-6. (PMID: 27236523)
    • Contributed Indexing:
      Keywords: extracellular volume; magnetic resonance imaging; myocardial infarction
    • Accession Number:
      0 (Contrast Media)
      0 (Tetrazolium Salts)
      7OL20RET2I (triphenyltetrazolium)
      K2I13DR72L (Gadolinium DTPA)
    • Publication Date:
      Date Created: 20151225 Date Completed: 20160928 Latest Revision: 20180314
    • Publication Date:
      20231215
    • Accession Number:
      10.1016/j.jcmg.2015.08.015
    • Accession Number:
      26699107