A simple MR algorithm for estimation of myocardial salvage following acute ST segment elevation myocardial infarction.
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.
Jensen
Christoph J
CJ
Department of Cardiology and Angiology, Elisabeth Hospital Essen, Klara-Kopp-Weg 1, Essen, Germany. c.jensen@contilia.de
Bleckmann
Dominik
D
Eberle
Holger C
HC
Nassenstein
Kai
K
Schlosser
Thomas
T
Sabin
Georg V
GV
Naber
Christoph K
CK
Bruder
Oliver
O
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
D003287:Contrast Media; C064925:gadodiamide; D019786:Gadolinium DTPA
Clin Res Cardiol. 2008 Jan;97(1):32-8
17694377
Lancet. 2003 Feb 1;361(9355):374-9
12573373
Circulation. 1999 Nov 9;100(19):1992-2002
10556226
Clin Res Cardiol. 2008 Oct;97(10):760-7
18516488
Circulation. 2004 Aug 31;110(9):e82-292
15339869
Clin Res Cardiol. 2009 Feb;98(2):94-100
18975024
J Am Coll Cardiol. 1988 Dec;12(6):1573-81
2973483
J Am Coll Cardiol. 2009 Feb 24;53(8):720-9
19232907
Br Heart J. 1990 Oct;64(4):241-7
2121199
Radiology. 2001 Jan;218(1):215-23
11152805
Am J Cardiol. 1990 Dec 15;66(20):1407-11
2123601
Lancet. 1997 Aug 30;350(9078):615-9
9288043
Circulation. 1977 Nov;56(5):786-94
912839
Circulation. 2006 Apr 18;113(15):1865-70
16606793
J Am Coll Cardiol. 2009 Feb 24;53(8):730-1
19232908
Clin Res Cardiol. 2007 Oct;96(10):743-51
17763966
Lancet. 2003 Jan 4;361(9351):13-20
12517460
N Engl J Med. 2003 Aug 21;349(8):733-42
12930925
Circulation. 2004 Nov 23;110(21):e506-10
15557381
Circulation. 2002 Jun 25;105(25):2946-9
12081985
J Am Coll Cardiol. 2008 Apr 22;51(16):1581-7
18420102
N Engl J Med. 2000 Nov 16;343(20):1445-53
11078769
Lancet. 2002 Mar 16;359(9310):920-5
11918909
Circulation. 2002 Oct 29;106(18):2322-7
12403661
Clin Res Cardiol. 2007 Feb;96(2):94-102
17160565
J Am Coll Cardiol. 1994 Aug;24(2):384-91
8034872
Circulation. 1982 Dec;66(6):1146-9
6754130
Am J Cardiol. 2000 Feb 1;85(3):299-304
11078296
Eur Heart J. 2006 Apr;27(7):779-88
16513663
J Am Coll Cardiol. 1998 May;31(6):1246-51
9581715