title: A simple MR algorithm for estimation of myocardial salvage following acute ST segment elevation myocardial infarction.
abstract: OBJECTIVE
  To assess myocardial salvage in acute ST segment elevation myocardial infarction (STEMI) by using contrast-enhanced CMR.
  
  
  METHODS
  Forty-four consecutive patients (38 male; mean age 59 +/- 10 years) with a first acute STEMI underwent acute percutaneous coronary intervention with successful restoration of TIMI grade 3 flow. CMR was performed 2 +/- 1 days after reperfusion on a standard 1.5 T MR Scanner that included a steady-state free precession cine imaging for LV function and an inversion-recovery fast low angle shot (TR 8 ms, TE 4 ms, FA 25 degrees ) sequences for late gadolinium enhancement (LGE) following the injection of 0.2 mmol/kg BW gadodiamide. The myocardium at risk (MR) was approximated by the volume of myocardium exhibiting LGE and/or impaired wall motion. The myocardial salvage index (MSI) was calculated as the volume of the MR minus the volume of LGE divided by the volume of the MR. Reperfusion therapy was rated successful with an ST elevation resolution (STR) > or =70% and was considered inadequate below 70%.
  
  
  RESULTS
  Infarct size (LGE) was 17 +/- 13% of LV mass, the mean STR was 53.4 +/- 28.3%, and the MSI was 10.9 +/- 6.2%. There was a good correlation between the MSI and the STR (r = 0.695, P < 0.0001). Thirty patients had an STR below 70%, and 14 patients had an STR greater than 70%. The MSI was greater in patients with a STE resolution of more than 70% (12 +/- 11 vs. 6 +/- 3%, P < 0.0001).
  
  
  CONCLUSIONS
  A simple MR algorithm based upon the relationship of functional impairment, which includes myocardial stunning, to the extent of LGE (infarct necrosis) is in accordance with STR as a clinical marker of successful reperfusion in acute myocardial infarction.
authors.affiliation: Department of Cardiology and Angiology, Elisabeth Hospital Essen, Klara-Kopp-Weg 1, Essen, Germany. c.jensen@contilia.de
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Jensen
authors.forename: Dominik
authors.initials: D
authors.lastname: Bleckmann
authors.forename: Holger C
authors.initials: HC
authors.lastname: Eberle
authors.forename: Kai
authors.initials: K
authors.lastname: Nassenstein
authors.forename: Thomas
authors.initials: T
authors.lastname: Schlosser
authors.forename: Georg V
authors.initials: GV
authors.lastname: Sabin
authors.forename: Christoph K
authors.initials: CK
authors.lastname: Naber
authors.forename: Oliver
authors.initials: O
authors.lastname: Bruder
mesh_terms: D000368:Aged; D000465:Algorithms; D015906:Angioplasty, Balloon, Coronary; D003287:Contrast Media; D003326:Coronary Circulation; D004562:Electrocardiography; D005240:Feasibility Studies; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D009203:Myocardial Infarction / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D009206:Myocardium / Q000473:pathology*; D009336:Necrosis; D011237:Predictive Value of Tests; D016896:Treatment Outcome; D016277:Ventricular Function, Left
chemical_list: D003287:Contrast Media; C064925:gadodiamide; D019786:Gadolinium DTPA
references.citation: Clin Res Cardiol. 2008 Jan;97(1):32-8
references.pmid: 17694377
references.citation: Lancet. 2003 Feb 1;361(9355):374-9
references.pmid: 12573373
references.citation: Circulation. 1999 Nov 9;100(19):1992-2002
references.pmid: 10556226
references.citation: Clin Res Cardiol. 2008 Oct;97(10):760-7
references.pmid: 18516488
references.citation: Circulation. 2004 Aug 31;110(9):e82-292
references.pmid: 15339869
references.citation: Clin Res Cardiol. 2009 Feb;98(2):94-100
references.pmid: 18975024
references.citation: J Am Coll Cardiol. 1988 Dec;12(6):1573-81
references.pmid: 2973483
references.citation: J Am Coll Cardiol. 2009 Feb 24;53(8):720-9
references.pmid: 19232907
references.citation: Br Heart J. 1990 Oct;64(4):241-7
references.pmid: 2121199
references.citation: Radiology. 2001 Jan;218(1):215-23
references.pmid: 11152805
references.citation: Am J Cardiol. 1990 Dec 15;66(20):1407-11
references.pmid: 2123601
references.citation: Lancet. 1997 Aug 30;350(9078):615-9
references.pmid: 9288043
references.citation: Circulation. 1977 Nov;56(5):786-94
references.pmid: 912839
references.citation: Circulation. 2006 Apr 18;113(15):1865-70
references.pmid: 16606793
references.citation: J Am Coll Cardiol. 2009 Feb 24;53(8):730-1
references.pmid: 19232908
references.citation: Clin Res Cardiol. 2007 Oct;96(10):743-51
references.pmid: 17763966
references.citation: Lancet. 2003 Jan 4;361(9351):13-20
references.pmid: 12517460
references.citation: N Engl J Med. 2003 Aug 21;349(8):733-42
references.pmid: 12930925
references.citation: Circulation. 2004 Nov 23;110(21):e506-10
references.pmid: 15557381
references.citation: Circulation. 2002 Jun 25;105(25):2946-9
references.pmid: 12081985
references.citation: J Am Coll Cardiol. 2008 Apr 22;51(16):1581-7
references.pmid: 18420102
references.citation: N Engl J Med. 2000 Nov 16;343(20):1445-53
references.pmid: 11078769
references.citation: Lancet. 2002 Mar 16;359(9310):920-5
references.pmid: 11918909
references.citation: Circulation. 2002 Oct 29;106(18):2322-7
references.pmid: 12403661
references.citation: Clin Res Cardiol. 2007 Feb;96(2):94-102
references.pmid: 17160565
references.citation: J Am Coll Cardiol. 1994 Aug;24(2):384-91
references.pmid: 8034872
references.citation: Circulation. 1982 Dec;66(6):1146-9
references.pmid: 6754130
references.citation: Am J Cardiol. 2000 Feb 1;85(3):299-304
references.pmid: 11078296
references.citation: Eur Heart J. 2006 Apr;27(7):779-88
references.pmid: 16513663
references.citation: J Am Coll Cardiol. 1998 May;31(6):1246-51
references.pmid: 9581715