Extent of myocardial scarring on nonstress delayed-contrast-enhancement cardiac magnetic resonance imaging correlates directly with degrees of resting regional dysfunction in chronic ischemic heart disease.
BACKGROUND
Hyper-enhancement on delayed-enhancement magnetic resonance imaging (DE-MRI) is a marker of irreversible myocardial injury. Both reversible and irreversible ischemically injured regions of myocardium develop reductions in systolic function compared with unaffected regions. This study evaluated whether there is a relationship between myocardial hyper-enhancement from remote scarring on DE-MRI and the degree of myocardial circumferential shortening (%CS) as determined with dynamic MRI tissue tagging (TAG-MRI) in the setting of chronic ischemic heart disease (CIHD).


METHODS
Thirty-five patients with CIHD and 8 control patients underwent nonstress, resting DE-MRI and TAG-MRI. A total of 168 CIHD and 96 control segments from the basal- and middle-thirds of the left ventricle (LV) were selected to achieve a balanced test set. With a 16-segment model, segmental myocardial scarring was graded on the basis of the amount of hyper-enhancement on DE-MRI. With TAG-MRI images, segmental %CS was calculated.


RESULTS
Patients with CIHD had lower LV ejection fraction compared with the control patients (28% vs 67%). The %CS of normal segments was notably different from %CS of CIHD segments, regardless of the presence or absence of myocardial hyper-enhancement on DE-MRI. Among the CIHD segments, however, %CS correlated inversely with the amount of myocardial hyper-enhancement from scarring (P <.0001, r = -0.38).


CONCLUSIONS
On cardiac MRI for CIHD, myocardial hyper-enhancement correlates inversely with %CS, supporting the direct relationship between the amount of remote myocardial scarring determined with nonstress DE-MRI and baseline resting functional impairment.
Srichai
Monvadi B
MB
Department of Radiology, Section of Cardiovascular Imaging, Cleveland Clinic Foundation, Ohio 44195, USA.
Schvartzman
Paulo R
PR
Sturm
Bernhard
B
Kasper
Jane M
JM
Lieber
Michael L
ML
White
Richard D
RD
D000328:Adult; D016022:Case-Control Studies; D002908:Chronic Disease; D003287:Contrast Media; D001026:Coronary Artery Bypass; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D009206:Myocardium / Q000473:pathology*; D049268:Positron-Emission Tomography; D015899:Tomography, Emission-Computed, Single-Photon; D018487:Ventricular Dysfunction, Left
D003287:Contrast Media