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Role of delayed contrast-enhanced magnetic resonance imaging for the prediction of functional improvement after reperfused acute myocardial infarction
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Abstract
Objective: To access the transmural extent of hyperenhancement at delayed contrast enhancement MRI on relating to left ventricular functional improvement in reperfused myocardial infarction and to compare the left ventricular morphology and function on MRI before and post percutaneous coronary revascularization.
Methods: Cine sequence and delayed Contrast-Enhanced MRI were underwent in period of 10 days just before or postpercutaneous coronary revascularization on 28 patients suffering from Acute Myocardial Infarction at Bach Mai hospital. Long term follow-up cardiac MRI was done to compare the change in left ventricular morphology and function. Myocardial wall
thickening and left ventricular volumes were quantified on cine-images, and the transmural extent of infarction (TEI) was scored on delayed-enhancement images.
Results: A decrease in myocardial mass (104,8 ± 23,89 to 95,83 ± 25,81, p<0,05), mean SWT score (16,75 ± 4,7 to 14,86 ± 5,98, p<0,001) and increase the mean ejection fraction (45,74 ± 7,25% to 49,12 ± 9,2%, mean 3,39%, p<0,05), whereas mean end-diastolic volume (109,49 ± 28,53 to 131,73 ± 39,37 ml, p<0,0001) and mean end-systolic volume (59,91 ± 19,13 to 69,19 ± 30,18, p<0,05) did not decrease. Segmental wall thickening did not change (42,12 ± 23,19 to 42,57 ± 23,99, p>0,5). The transmural extent of hyperenhancement at DCE-MRI was related to left ventricular remodeling (r=0,628, p-0,0001) and ejection fraction(r=0,583, p=0,001). Segmental wall thickening improved significantly in segments with<25% TEI(35 ± 7,39 to 48,86 ± 6,65, p<0,0001), tended to improve in segments with 25% to 75% TEI (32,88± 9,78 to 39,67 ± 10,7, p<0,001), whereas segments with>75% TEI did not improve (22,61 ± 14,62 to 19,71 ± 14,56, p<0,05).
Conclusion: In patients with recent reperfused MI, functional improvement predicted by delayed contrast-enhanced Magnetic Resonance Imaging.
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Keywords
Cardiac Magnetic Resonace Imaging, delayed enhancement MRI, late gadolinium,, Acute myocardial infarction, transmural extent of infarction (TEI)
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