title: Multi-vendor, multicentre comparison of contrast-enhanced SSFP and T2-STIR CMR for determining myocardium at risk in ST-elevation myocardial infarction.
abstract: OBJECTIVE
  Myocardial salvage, determined by cardiac magnetic resonance imaging (CMR), is used as end point in cardioprotection trials. To calculate myocardial salvage, infarct size is related to myocardium at risk (MaR), which can be assessed by T2-short tau inversion recovery (T2-STIR) and contrast-enhanced steady-state free precession magnetic resonance imaging (CE-SSFP). We aimed to determine how T2-STIR and CE-SSFP perform in determining MaR when applied in multicentre, multi-vendor settings.
  
  
  RESULTS
  A total of 215 patients from 17 centres were included after percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction. CMR was performed within 1-8 days. These patients participated in the MITOCARE or CHILL-MI cardioprotection trials. Additionally, 8 patients from a previous study, imaged 1 day post-CMR, were included. Late gadolinium enhancement, T2-STIR, and CE-SSFP images were acquired on 1.5T MR scanners (Philips, Siemens, or GE). In 65% of the patients, T2-STIR was of diagnostic quality compared with 97% for CE-SSFP. In diagnostic quality images, there was no difference in MaR by T2-STIR and CE-SSFP (bias: 0.02 ± 6%, P = 0.96, r(2) = 0.71, P < 0.001), or between treatment and control arms. No change in size or quality of MaR nor ability to identify culprit artery was seen over the first week after the acute event (P = 0.44).
  
  
  CONCLUSIONS
  In diagnostic quality images, T2-STIR and CE-SSFP provide similar estimates of MaR, were constant over the first week, and were not affected by treatment. CE-SSFP had a higher degree of diagnostic quality images compared with T2 imaging for sequences from two out of three vendors. Therefore, CE-SSFP is currently more suitable for implementation in multicentre, multi-vendor clinical trials.
authors.affiliation: Department of Clinical Physiology, Clinical Sciences, Lund University, Lund, Sweden.
authors.forename: David
authors.initials: D
authors.lastname: Nordlund
authors.affiliation: University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Gert
authors.initials: G
authors.lastname: Klug
authors.affiliation: Department of Clinical Physiology, Clinical Sciences, Lund University, Lund, Sweden Department of Biomedical Engineering, Faculty of Engineering, Lund University, Sweden.
authors.forename: Einar
authors.initials: E
authors.lastname: Heiberg
authors.affiliation: Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.
authors.forename: Sasha
authors.initials: S
authors.lastname: Koul
authors.affiliation: Department of Heart Disease, Haukeland University Hospital, Bergen Department of Biomedicine, University of Bergen, Bergen, Norway.
authors.forename: Terje H
authors.initials: TH
authors.lastname: Larsen
authors.affiliation: Section for Interventional Cardiology, Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway.
authors.forename: Pavel
authors.initials: P
authors.lastname: Hoffmann
authors.affiliation: University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Metzler
authors.affiliation: Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.
authors.forename: David
authors.initials: D
authors.lastname: Erlinge
authors.affiliation: Department of Cardiology B, Oslo University Hospital Ullevål, University of Oslo, Oslo, Norway.
authors.forename: Dan
authors.initials: D
authors.lastname: Atar
authors.affiliation: Department of Clinical Physiology, Clinical Sciences, Lund University, Lund, Sweden Laboratory of Medical Informatics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Anthony H
authors.initials: AH
authors.lastname: Aletras
authors.affiliation: Department of Clinical Physiology, Clinical Sciences, Lund University, Lund, Sweden.
authors.forename: Marcus
authors.initials: M
authors.lastname: Carlsson
authors.affiliation: Department of Clinical Physiology, Clinical Sciences, Lund University, Lund, Sweden.
authors.forename: Henrik
authors.initials: H
authors.lastname: Engblom
authors.affiliation: Department of Clinical Physiology, Clinical Sciences, Lund University, Lund, Sweden hakan.arheden@med.lu.se.
authors.forename: Håkan
authors.initials: H
authors.lastname: Arheden
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D016022:Case-Control Studies; D003287:Contrast Media; D017023:Coronary Angiography / Q000379:methods*; D016208:Databases, Factual; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010091:Oximes / Q000627:therapeutic use; D011379:Prognosis; D011856:Radiographic Image Enhancement; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D012632:Secosteroids / Q000627:therapeutic use; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D010091:Oximes; D012632:Secosteroids; C549911:3,5-seco-4-norcholestan-5-one oxime-3-ol; D019786:Gadolinium DTPA
keywords: AAR; area at risk; ischaemia; magnetic resonance imaging; myocardium at risk