title: Assessment of myocardium at risk with contrast enhanced steady-state free precession cine cardiovascular magnetic resonance compared to single-photon emission computed tomography.
abstract: BACKGROUND
  Final infarct size following coronary occlusion is determined by the duration of ischemia, the size of myocardium at risk (MaR) and reperfusion injury. The reference method for determining MaR, single-photon emission computed tomography (SPECT) before reperfusion, is impractical in an acute setting. The aim of the present study was to evaluate whether MaR can be determined from the contrast enhanced myocardium using steady-state free precession (SSFP) cine cardiovascular magnetic resonance (CMR) performed one week after the acute event in ST-elevation myocardial infarction (STEMI) patients with total coronary occlusion.
  
  
  RESULTS
  Sixteen patients with STEMI (age 64 +/- 8 years) received intravenous 99 m-Tc immediately before primary percutaneous coronary intervention. SPECT was performed within four hours. MaR was defined as the non-perfused myocardial volume derived with SPECT. CMR was performed 7.8 +/- 1.2 days after the myocardial infarction using a protocol in which the contrast agent was administered before acquisition of short-axis SSFP cines. MaR was evaluated as the contrast enhanced myocardial volume in the cines by two blinded observers. MaR determined from the enhanced region on cine CMR correlated significantly with that derived with SPECT (r2 = 0.78, p < 0.001). The difference in MaR determined by CMR and SPECT was 0.5 +/- 5.1% (mean +/- SD). The interobserver variability of contrast enhanced cine SSFP measurements was 1.6 +/- 3.7% (mean +/- SD) of the left ventricle wall volume.
  
  
  CONCLUSIONS
  Contrast enhanced SSFP cine CMR performed one week after acute infarction accurately depicts MaR prior to reperfusion in STEMI patients with total occlusion undergoing primary PCI. This suggests that a single CMR examination might be performed for determination of MaR and infarct size.
authors.affiliation: Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Peder
authors.initials: P
authors.lastname: Sörensson
authors.forename: Einar
authors.initials: E
authors.lastname: Heiberg
authors.forename: Nawsad
authors.initials: N
authors.lastname: Saleh
authors.forename: Frederic
authors.initials: F
authors.lastname: Bouvier
authors.forename: Kenneth
authors.initials: K
authors.lastname: Caidahl
authors.forename: Per
authors.initials: P
authors.lastname: Tornvall
authors.forename: Lars
authors.initials: L
authors.lastname: Rydén
authors.forename: John
authors.initials: J
authors.lastname: Pernow
authors.forename: Håkan
authors.initials: H
authors.lastname: Arheden
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003287:Contrast Media; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D019786:Gadolinium DTPA; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology / Q000628:therapy; D009206:Myocardium / Q000473:pathology*; D015588:Observer Variation; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; C064925:gadodiamide; D019786:Gadolinium DTPA