Anzeige
Erschienen in:
01.08.2012 | Cardiac
Electro-mechanical characteristics of myocardial infarction border zones and ventricular arrhythmic risk: novel insights from grid-tagged cardiac magnetic resonance imaging
Erschienen in: European Radiology | Ausgabe 8/2012
Einloggen, um Zugang zu erhaltenAbstract
Objective
To investigate whether grid-tag myocardial strain evaluation can characterise ‘border-zone’ peri-infarct region and identify patients at risk of ventricular arrhythmia as the peri-infarct myocardial zone may represent an important contributor to ventricular arrhythmia following ST-segment elevation myocardial infarction (STEMI).
Methods
Forty-five patients with STEMI underwent cardiac magnetic resonance (CMR) imaging on days 3 and 90 following primary percutaneous coronary intervention (PCI). Circumferential peak circumferential systolic strain (CS) and strain rate (CSR) were calculated from grid-tagged images. Myocardial segments were classified into ‘infarct’, ‘border-zone’, ‘adjacent’ and ‘remote’ regions by late-gadolinium enhancement distribution. The relationship between CS and CSR and these distinct myocardial regions was assessed. Ambulatory Holter monitoring was performed 14 days post myocardial infarction (MI) to estimate ventricular arrhythmia risk via evaluation of heart-rate variability (HRV).
Results
We analysed 1,222 myocardial segments. Remote and adjacent regions had near-normal parameters of CS and CSR. Border-zone regions had intermediate CS (-9.0 ± 4.6 vs -5.9 ± 7.4, P < 0.001) and CSR (-86.4 ± 33.3 vs -73.5 ± 51.4, P < 0.001) severity compared with infarct regions. Patients with ‘border-zone’ peri-infarct regions had reduced very-low-frequency power on HRV analysis, which is a surrogate for ventricular arrhythmia risk (P = 0.03).
Conclusion
Grid-tagged CMR-derived myocardial strain accurately characterises the mechanical characteristics of ‘border-zone’ peri-infarct region. Presence of ‘border-zone’ peri-infarct region correlated with a surrogate marker of heightened arrhythmia risk following STEMI.
Key Points
• Grid-tagged cardiac magnetic resonance (CMR) offers new insights into myocardial mechanical function.
• Grid-tagged CMR identified different characteristics in ‘border-zone’ and ‘adjacent’ peri-infarct myocardial regions.
• Reduced very-low-frequency (VLF) power is associated with arrhythmic and mortality risk.
• The presence of ‘border-zone’ peri-infarct region correlated with reduced VLF power.