Timing of cardiovascular magnetic resonance in clinical trials evaluating cardioprotective therapies to reduce infarct size

2021 ◽  
Vol 323 ◽  
pp. 272-274
Author(s):  
Joseph B. Selvanayagam ◽  
Rajiv Ananthakrishna ◽  
Cheerag Shirodaria ◽  
Keith Channon
Keyword(s):  
Clinical Trials ◽  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Infarct Size ◽  
Reduce Infarct Size

Abstract 13610: Native T1-based Cardiovascular Magnetic Resonance Imaging for Characterizing Chronic Myocardial Infarctions in Patients

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Avinash Kali ◽  
Eui Y Choi ◽  
Behzad Sharif ◽  
Young J Kim ◽  
Xiaoming Bi ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Infarct Size ◽  
Sensitivity And Specificity ◽  
Remote Myocardium ◽  
Myocardial Infarctions ◽  
Native T1 ◽  
Threshold Criterion ◽  
Acute Mi ◽  
End Stage

Introduction: Late Gadolinium Enhancement (LGE) Cardiovascular Magnetic Resonance (CMR) is the gold standard for characterizing chronic myocardial infarctions (MIs), but it is contraindicated in patients with end-stage chronic kidney disease. Hypothesis: We investigated whether native T1 mapping at 3T can reliably characterize chronic MIs in two pilot patient populations with prior STEMI and NSTEMI. Methods: Patients with prior STEMI (n=15) and NSTEMI (n=17) underwent CMR at a median of 13.6 years after acute MI and native T1 maps and LGE images were acquired. Infarct location, size and transmurality were measured from LGE and T1 maps using standard threshold criterion and compared against one another. Visual conspicuity for detecting chronic MI territories on LGE images and T1 maps were assessed by independent reviewers. Results: LGE images and native T1 maps were not different for measuring infarct size (STEMI: p=0.87; NSTEMI: p=0.93) and transmurality (STEMI: p=0.19; NSTEMI: p=0.24). Statistical analyses showed good agreement between LGE images and T1 maps for measuring infarct size (STEMI: bias = -0.4±2.1%; R2=0.97; NSTEMI: bias = -1.1±3.9%; R2=0.87) and transmurality (STEMI: bias = 1.5±2.9%; R2=0.99; NSTEMI: bias = -2.2±7.4%; R2=0.71). Sensitivity and specificity of native T1 maps for detecting chronic MIs based on threshold criterion were 93% and 97% respectively (STEMI); and 93% and 92% respectively (NSTEMI). Mean visual conspicuity score for detecting chronic MI on LGE images was greater than that of native T1 maps (p<0.001). Sensitivity and specificity of native T1 maps using visual detection were: 61% and 85% (STEMI); and 67% and 90% (NSTEMI). Conclusions: Chronic MIs in STEMI and NSTEMI patients can be reliably characterized using threshold-based detection with native T1 maps when the location of remote myocardium is known. The current visual detectability of remote myocardium on native T1 maps has a certainty of 85% in STEMI and 90% in NSTEMI patients.

scholarly journals Infarct size by cardiovascular magnetic resonance with delay enhancement as prognostic factor in the coronary artery disease: preliminary study

2009 ◽  
Vol 11 (S1) ◽  
Author(s):  
Leticia Castellanos Cainas ◽  
Sandra Graciela Rosales Uvera ◽  
Jaime Galindo Uribe ◽  
Jorge Vazquez La Madrid ◽  
Jorge Oseguera Moguel ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Cardiovascular Magnetic Resonance ◽  
Coronary Artery ◽  
Magnetic Resonance ◽  
Prognostic Factor ◽  
Infarct Size ◽  
Delay Enhancement ◽  
Preliminary Study ◽  
Artery Disease

Abstract 14877: Native T1-based Cardiovascular Magnetic Resonance for Characterizing Chronic Myocardial Infarctions: Proof-of-Concept Study in Canines

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Avinash Kali ◽  
Ivan Cokic ◽  
Richard L Tang ◽  
Hsin J Yang ◽  
Behzad Sharif ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Infarct Size ◽  
T1 Mapping ◽  
Ischemia Reperfusion Injury ◽  
Ex Vivo ◽  
Ischemia Reperfusion ◽  
Infarcted Myocardium ◽  
Native T1 ◽  
Replacement Fibrosis

Introduction: Gadolinium infusion required for Late Gadolinium Enhancement (LGE) Cardiovascular Magnetic Resonance (CMR) imaging is contraindicated in nearly 20% of myocardial infarction (MI) patients due to chronic end-stage kidney disease. Hypothesis: Using a canine model of MI, we investigated whether native T1 mapping at 3T could be an alternative to LGE CMR for characterizing chronic MIs (CMIs). Methods: Canines (n=29) were subjected to ischemia-reperfusion injury. Native T1 maps, native T2 maps and LGE images were acquired at 7 days (acute, AMI) and 4 months (CMI) post-MI at 1.5T and 3T. Infarct location, size and transmurality, measured using Mean + 5 Standard Deviations criterion, were compared between T1 maps and LGE images. Native T2 maps were used to examine the resolution of edema between AMI and CMI. Following the CMR studies, animals were euthanized and ex-vivo histology was performed. Results: T1 maps and LGE images were not different for measuring infarct size (p=0.61) and transmurality (p=0.81) in CMI at 3T. In AMI at 3T, T1 maps overestimated both infarct size (p=0.007) and transmurality (p=0.007) relative to LGE images. At 1.5T, T1 maps underestimated both infarct size and transmurality relative to LGE images in both AMI and CMI (p<0.001 for all cases). Relative to the remote territories, T1 of the infarcted myocardium was elevated in AMI (3T: p<0.001; 1.5T: p<0.001) and CMI (3T: p<0.001; 1.5T: p=0.037). T2 of the infarcted myocardium was elevated in AMI (p<0.001 at both 3T and 1.5T), but not in CMI (3T: p=0.19, 1.5T: p=0.55) indicating that myocardial edema resolved by 4 months post-MI. Masson’s trichrome staining showed extensive replacement fibrosis within CMIs. Sensitivity and specificity of T1 maps to detect CMI were 95% and 97% respectively at 3T, and 58% and 78% respectively at 1.5T. Conclusions: Native T1 mapping at 3T can characterize CMIs with high diagnostic accuracy. T1 elongations in CMI appear to arise predominantly from replacement fibrosis.

scholarly journals Hyper-acute cardiovascular magnetic resonance T1 mapping predicts infarct characteristics in patients with ST elevation myocardial infarction

2020 ◽  
Vol 22 (1) ◽  
Author(s):  
Mohammad Alkhalil ◽  
◽  
Alessandra Borlotti ◽  
Giovanni Luigi De Maria ◽  
Mathias Wolfrum ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Infarct Size ◽  
Myocardial Injury ◽  
T1 Mapping ◽  
Characteristic Analysis ◽  
Area At Risk ◽  
Severity Of Injury ◽  
Final Infarct Size

Abstract Background Myocardial recovery after primary percutaneous coronary intervention in acute myocardial infarction is variable and the extent and severity of injury are difficult to predict. We sought to investigate the role of cardiovascular magnetic resonance T1 mapping in the determination of myocardial injury very early after treatment of ST-segment elevation myocardial infarction (STEMI). Methods STEMI patients underwent 3 T cardiovascular magnetic resonance (CMR), within 3 h of primary percutaneous intervention (PPCI). T1 mapping determined the extent (area-at-risk as %left ventricle, AAR) and severity (average T1 values of AAR) of acute myocardial injury, and related these to late gadolinium enhancement (LGE), and microvascular obstruction (MVO). The characteristics of myocardial injury within 3 h was compared with changes at 24-h to predict final infarct size. Results Forty patients were included in this study. Patients with average T1 values of AAR ≥1400 ms within 3 h of PPCI had larger LGE at 24-h (33% ±14 vs. 18% ±10, P = 0.003) and at 6-months (27% ±9 vs. 12% ±9; P < 0.001), higher incidence and larger extent of MVO (85% vs. 40%, P = 0.016) & [4.0 (0.5–9.5)% vs. 0 (0–3.0)%, P = 0.025]. The average T1 value was an independent predictor of acute LGE (β 0.61, 95%CI 0.13 to 1.09; P = 0.015), extent of MVO (β 0.22, 95%CI 0.03 to 0.41, P = 0.028) and final infarct size (β 0.63, 95%CI 0.21 to 1.05; P = 0.005). Receiver-operating-characteristic analysis showed that T1 value of AAR obtained within 3-h, but not at 24-h, predicted large infarct size (LGE > 9.5%) with 100% positive predictive value at the optimal cut-off of 1400 ms (area-under-the-curve, AUC 0.88, P = 0.006). Conclusion Hyper-acute T1 values of the AAR (within 3 h post PPCI, but not 24 h) predict a larger extent of MVO and infarct size at both 24 h and 6 months follow-up. Delayed CMR scanning for 24 h could not substitute the significant value of hyper-acute average T1 in determining infarct characteristics.

Sign in / Sign up

Export Citation Format

Share Document