Clinical research
Delayed contrast-enhanced magnetic resonance imaging for the prediction of regional functional improvement after acute myocardial infarction

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Abstract

Objectives

We evaluated whether delayed contrast-enhanced magnetic resonance imaging (DCE-MRI) using an extracellular contrast agent could predict improvement of dysfunctional but viable myocardium after acute reperfused myocardial infarction (MI).

Background

The transmural extent of hyperenhancement at DCE-MRI has been related to improvement of function in reperfused MI. However, evidence is still limited, and earlier reports have produced conflicting results regarding the significance of contrast patterns after infarction.

Methods

Thirty patients (mean age 59 ± 11 years, 27 males) underwent cine MRI and DCE-MRI 7 ± 3 days after a first reperfused acute MI and follow-up cine MRI at 13 ± 3 weeks. Segmental wall thickening and segmental extent of hyperenhancement were scored in 1,689 segments.

Results

Of 500 dysfunctional segments, 273 (55%) improved at follow-up. There was no difference in likelihood of improvement or complete functional recovery between segments with 0% and 1% to 25% hyperenhancement. The likelihood of improvement of segments without hyperenhancement was 2.9, 14.3, and 20 times higher than that of segments with 26% to 50%, 51% to 75%, and >75% hyperenhancement, respectively (p < 0.001). The likelihood of complete functional recovery of segments without hyperenhancement was 3.8, 11.1, and 50 times higher than that of segments with 26% to 50%, 51% to 75%, and >75% hyperenhancement, respectively (p < 0.001).

Conclusions

In patients with recent reperfused MI, functional improvement of stunned myocardium is predicted by DCE-MRI.

Abbreviations

AMI
acute myocardial infarction
CK
creatine kinase
DCE
delayed contrast-enhanced
DTPA
diethylenetriamine pentaacetic acid
ECG
electrocardiogram
EF
ejection fraction
MI
myocardial infarction
MRI
magnetic resonance imaging
PTCA
percutaneous transluminal coronary angioplasty
SEH
segmental extent of hyperenhancement
SEHth
SEH scored after thresholding the window setting of contrast images
SWT
segmental wall thickening
TI
inversion time

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This study was supported by the Netherlands Heart Foundation (O.B., grant 2001.158) and the Interuniversity Cardiology Institute of the Netherlands.