title: Cardiovascular magnetic resonance imaging of myocardial oedema following acute myocardial infarction: Is whole heart coverage necessary?
abstract: BACKGROUND
  AAR measurement is useful when assessing the efficacy of reperfusion therapy and novel cardioprotective agents after myocardial infarction. Multi-slice (Typically 10-12) T2-STIR has been used widely for its measurement, typically with a short axis stack (SAX) covering the entire left ventricle, which can result in long acquisition times and multiple breath holds. This study sought to compare 3-slice T2-short-tau inversion recovery (T2- STIR) technique against conventional multi-slice T2-STIR technique for the assessment of area at risk (AAR).
  
  
  METHODS
  CMR imaging was performed on 167 patients after successful primary percutaneous coronary intervention. 82 patients underwent a novel 3-slice SAX protocol and 85 patients underwent standard 10-slice SAX protocol. AAR was obtained by manual endocardial and epicardial contour mapping followed by a semi- automated selection of normal myocardium; the volume was expressed as mass (%) by two independent observers.
  
  
  RESULTS
  85 patients underwent both 10-slice and 3-slice imaging assessment showing a significant and strong correlation (intraclass correlation coefficient = 0.92;p < 0.0001) and a low Bland-Altman limit (mean difference -0.03 ± 3.21%, 95% limit of agreement,- 6.3 to 6.3) between the 2 analysis techniques. A further 82 patients underwent 3-slice imaging alone, both the 3-slice and the 10-slice techniques showed statistically significant correlations with angiographic risk scores (3-slice to BARI r = 0.36, 3-slice to APPROACH r = 0.42, 10-slice to BARI r = 0.27, 10-slice to APPROACH r = 0.46). There was low inter-observer variability demonstrated in the 3-slice technique, which was comparable to the 10-slice method (z = 1.035, p = 0.15). Acquisition and analysis times were quicker in the 3-slice compared to the 10-slice method (3-slice median time: 100 seconds (IQR: 65-171 s) vs. (10-slice time: 355 seconds (IQR: 275-603 s); p < 0.0001.
  
  
  CONCLUSIONS
  AAR measured using 3-slice T2-STIR technique correlates well with standard 10-slice techniques, with no significant bias demonstrated in assessing the AAR. The 3-slice technique requires less time to perform and analyse and is therefore advantageous for both patients and clinicians.
authors.affiliation: Department of Cardiology, Barts Heart Centre, St Bartholomews Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK. stephenmark.hamshere@bartshealth.nhs.uk.
authors.forename: Stephen
authors.initials: S
authors.lastname: Hamshere
authors.affiliation: Department of Cardiology, Barts Heart Centre, St Bartholomews Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK. danieljones@doctors.org.uk.|William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK. danieljones@doctors.org.uk.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Jones
authors.affiliation: Department of Cardiology, Barts Heart Centre, St Bartholomews Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK. cyril.pellaton@chuv.ch.
authors.forename: Cyril
authors.initials: C
authors.lastname: Pellaton
authors.affiliation: Department of Cardiology, Barts Heart Centre, St Bartholomews Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK. Danielle.zaugg@chuv.ch.
authors.forename: Danielle
authors.initials: D
authors.lastname: Longchamp
authors.affiliation: Department of Cardiology, Barts Heart Centre, St Bartholomews Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK. tom.burchell@gmail.com.
authors.forename: Tom
authors.initials: T
authors.lastname: Burchell
authors.affiliation: Department of Cardiology, Barts Heart Centre, St Bartholomews Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK. saidi.mohiddin@bartshealth.nhs.uk.
authors.forename: Saidi
authors.initials: S
authors.lastname: Mohiddin
authors.affiliation: Department of Cardiology, Barts Heart Centre, St Bartholomews Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK. james.moon@bartshealth.nhs.uk.
authors.forename: James C
authors.initials: JC
authors.lastname: Moon
authors.affiliation: Department of Cardiology, Rigshopitale, University of Copenhagen, Copenhagen, Denmark. Jens.kastrup@regionh.bk.
authors.forename: Jens
authors.initials: J
authors.lastname: Kastrup
authors.affiliation: Department of Cardiology, Barts Heart Centre, St Bartholomews Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK. dlocca@cygcl.ch.|Service de Cardiologie et Département de Médecine Interne, Centre Hospitalier Universitaire, Vaudois, Lausanne, Switzerland. dlocca@cygcl.ch.
authors.forename: Didier
authors.initials: D
authors.lastname: Locca
authors.affiliation: Department of Cardiology, Barts Heart Centre, St Bartholomews Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK. s.e.petersen@qmul.ac.uk.|William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK. s.e.petersen@qmul.ac.uk.
authors.forename: Steffen E
authors.initials: SE
authors.lastname: Petersen
authors.affiliation: Department of Cardiology, Barts Heart Centre, St Bartholomews Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK. mark.westwood@bartshealh.nhs.uk.
authors.forename: Mark
authors.initials: M
authors.lastname: Westwood
authors.affiliation: Department of Cardiology, Barts Heart Centre, St Bartholomews Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK. a.mathur@qmul.ac.uk.|William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK. a.mathur@qmul.ac.uk.
authors.forename: Anthony
authors.initials: A
authors.lastname: Mathur
mesh_terms: D000368:Aged; D002986:Clinical Trials as Topic; D003287:Contrast Media; D004489:Edema, Cardiac / Q000209:etiology / Q000473:pathology*; D005060:Europe; D005260:Female; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008536:Meglumine; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000473:pathology* / Q000628:therapy; D009206:Myocardium / Q000473:pathology*; D015588:Observer Variation; D009942:Organometallic Compounds; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D015203:Reproducibility of Results
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; D008536:Meglumine; C072417:gadoterate meglumine