title: Potential of delayed gadolinium enhancement magnetic resonance imaging for quantification of reverse remodeling of the peri-infarct zone in patients with ischemic cardiomyopathy treated with chronic vasodilator therapy: initial experience.
abstract: OBJECTIVE
  The peri-infarct zone represents the morphologic substrate for reentry ventricular tachycardia after myocardial infarction, and its extent is a strong predictor of major cardiac events. Although delayed gadolinium enhancement magnetic resonance imaging (DGE-MRI) was shown to allow for detailed characterization of myocardial infarction by quantifying infarct core zone and peri-infarct zone volume, potentials of DGE-MRI for measuring changes in peri-infarct zone volume are unknown. Therefore, we aimed to assess changes in volume of the peri-infarct zone among patients with ischemic cardiomyopathy treated with chronic vasodilator therapy.
  
  
  METHODS
  Core and peri-infarct zone volumes as assessed with DGE-MRI were measured in 5 patients at baseline and after 6 months treatment with sustained-release dipyridamole.
  
  
  RESULTS
  Core zone volume remained stable during follow-up [median (range), 19 mL (9 to 42) vs. 16 mL (11 to 46); P=0.785]. The ratio between the peri-infarct zone and the core zone volume decreased significantly at 6 months compared with baseline [median (range), 0.22 (0.19 to 0.42) vs. 0.18 (0.09 to 0.32); P=0.043], and a trend toward reduction in peri-infarct zone volume was found [median (range), 5 mL (2 to 8) vs. 3 mL (2 to 6); P=0.059]. The peri-infarct zone volume decreased in all but 1 patient over the follow-up.
  
  
  CONCLUSIONS
  This initial experience suggests that reverse remodeling of the peri-infarct zone with reduction in peri-infarct zone volume may take place in patients with ischemic cardiomyopathy. Quantification of this process may be feasible with DGE-MRI, but further studies are needed to confirm this hypothesis and to further clarify the role of DGE-MRI for the assessment of changes in peri-infarct zone volume in patients with ischemic cardiomyopathy.
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California San Francisco, USA.
authors.forename: Stefano
authors.initials: S
authors.lastname: Muzzarelli
authors.forename: Karen G
authors.initials: KG
authors.lastname: Ordovas
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cannavale
authors.forename: David
authors.initials: D
authors.lastname: Naeger
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Michaels
authors.forename: Charles B
authors.initials: CB
authors.lastname: Higgins
mesh_terms: D000328:Adult; D000368:Aged; D009202:Cardiomyopathies / Q000188:drug therapy* / Q000473:pathology*; D003287:Contrast Media; D017023:Coronary Angiography; D003326:Coronary Circulation; D004176:Dipyridamole / Q000627:therapeutic use*; D004562:Electrocardiography; D005260:Female; D005682:Gadolinium; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000473:pathology*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D015899:Tomography, Emission-Computed, Single-Photon; D014665:Vasodilator Agents / Q000627:therapeutic use*; D020257:Ventricular Remodeling
chemical_list: D003287:Contrast Media; D014665:Vasodilator Agents; D004176:Dipyridamole; D005682:Gadolinium