A protocol to evaluate myocardial viability in ischemic left ventricular dysfunction using magnetic resonance imaging and a gadolinium-based contrast agent.
OBJECTIVE
A protocol to evaluate myocardial viability in ischemic left ventricular dysfunction using magnetic resonance imaging and a gadolinium-based contrast agent.


METHODS
Twenty-two patients were prospectively offered a cardiac MR exam between November 2003 and June 2004. Twelve had a history of anterior wall MI, eight had a history of inferior wall MI and two patients had MI of undetermined location. Eight patients had left ventricular dysfunction.


RESULTS
No patient with transmural scarring extending through more than 75% of the wall recovered normal wall motion despite revascularization when evaluated fourteen months later. Of the other three with scarring extending to less than 75% there was recovery in two patients.


CONCLUSIONS
Viability assessment by cardiac MR using gadolinium contrast is a robust technique. No segment with >75% transmural enhancement (TE) recovers despite revascularization, while all segments with <25% TE recover contractility. Between these two extremes, methods other than extent of TE may have to be used, particularly low-dose dobutamine stress testing or evaluation of percentage of hyperenhanced area compared to the normal area in each segment.
Thomas
Boban
B
RM Caselas, Lisboa, Portugal. boban_thomas@lycos.com
Tavares
Nuno Jalles
NJ
D002985:Clinical Protocols; D003287:Contrast Media; D005682:Gadolinium; D006801:Humans; D008279:Magnetic Resonance Imaging; D008536:Meglumine; D017202:Myocardial Ischemia / Q000473:pathology*; D009206:Myocardium / Q000473:pathology*; D009942:Organometallic Compounds; D011446:Prospective Studies; D018487:Ventricular Dysfunction, Left / Q000473:pathology*
D003287:Contrast Media; D009942:Organometallic Compounds; D008536:Meglumine; D005682:Gadolinium; C072417:gadoterate meglumine