title: Enhancement patterns detected by multidetector computed tomography are associated with microvascular obstruction and left ventricular remodelling in patients with acute myocardial infarction.
abstract: OBJECTIVE
  This study evaluated the clinical value of myocardial contrast-delayed enhancement (DE) with multidetector computed tomography (MDCT) for detecting microvascular obstruction (MVO) and left ventricular (LV) remodelling revealed by DE magnetic resonance imaging after acute myocardial infarction (AMI).
  
  
  RESULTS
  In 92 patients with first AMI, MDCT without iodine reinjection was performed immediately following successful percutaneous coronary intervention (PCI). Delayed-enhancement magnetic resonance imaging performed in the acute and chronic phases was used to detect MVO and LV remodelling (any increase in LV end-systolic volume at 6 months after infarction compared with baseline). Patients were divided into two groups according to the presence (n = 33) or absence (n = 59) of heterogeneous enhancement (HE). Heterogeneous enhancement was defined as concomitant presence of hyper- and hypoenhancement within the infarcted myocardium on MDCT. Microvascular obstruction and LV remodelling were detected in 49 (53%) and 29 (32%) patients, respectively. In a multivariable analysis, HE and a relative CT density >2.20 were significant independent predictors for MVO [odds ratio (OR) 13.5; 95% confidence interval (CI), 2.15-84.9; P = 0.005 and OR 12.0; 95% CI, 2.94-49.2; P < 0.001, respectively). The presence of HE and relative CT density >2.20 showed a high positive predictive value of 93%, and the absence of these two findings yielded a high negative predictive value of 90% for the predictive value of MVO. Heterogeneous enhancement was significantly associated with LV remodelling (OR 6.75; 95% CI, 1.56-29.29; P = 0.011).
  
  
  CONCLUSIONS
  Heterogeneous enhancement detected by MDCT immediately after primary PCI may provide promising information for predicting MVO and LV remodelling in patients with AMI.
authors.affiliation: Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Watabe
authors.affiliation: Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan asato@md.tsukuba.ac.jp.
authors.forename: Akira
authors.initials: A
authors.lastname: Sato
authors.affiliation: Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan.
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Nishina
authors.affiliation: Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Hoshi
authors.affiliation: Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan.
authors.forename: Akinori
authors.initials: A
authors.lastname: Sugano
authors.affiliation: Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Kakefuda
authors.affiliation: Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan.
authors.forename: Yui
authors.initials: Y
authors.lastname: Takaiwa
authors.affiliation: Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Aihara
authors.affiliation: Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Fumikura
authors.affiliation: Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Noguchi
authors.affiliation: Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan.
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Aonuma
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000379:methods; D054059:Coronary Occlusion / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods; D008297:Male; D055806:Microvessels / Q000000981:diagnostic imaging; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods; D064847:Multimodal Imaging / Q000379:methods; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000473:pathology; D062645:Percutaneous Coronary Intervention / Q000379:methods; D012044:Regression Analysis; D012307:Risk Factors; D020257:Ventricular Remodeling / Q000502:physiology*
keywords: Acute myocardial infarction; Delayed-enhancement magnetic resonance imaging; Microvascular obstruction; Multidetector computed tomography; Percutaneous coronary intervention