Stijntje Dorien Roes MD, Presenter: Nothing to Disclose

Theodorus Albertus Kaandorp MD, Abstract Co-Author: Nothing to Disclose

Jeroen J Bax MD, Abstract Co-Author: Nothing to Disclose

Ernst Van der Wall, Abstract Co-Author: Nothing to Disclose

Hildo J. Lamb PhD, Abstract Co-Author: Nothing to Disclose

Albert De Roos MD, Abstract Co-Author: Nothing to Disclose

Microvascular obstruction (MO) occurs in patients after acute myocardial infarction (AMI) and is associated with poor clinical outcome and adverse left ventricular (LV) remodeling. MO can be assessed with first-pass perfusion (FP) and delayed contrast-enhanced (DE) magnetic resonance imaging (MRI). The purpose of this study was to investigate the value of MO assessed with either FP or DE MRI, in predicting LV remodeling at follow-up in patients after AMI.

We studied 27 patients within 10 days after AMI and 8.7±5.5 months later with cine MRI, FP and DE MRI using Gadolinium-DTPA. LV volumes, LV function and infarct size were assessed. The presence of MO was determined at FP images (MO-FP) and at DE images (MO-DE).

MO-FP was present in 18 of the 27 patients (67%). In 12 of these 18 patients (67%), MO-DE was observed as well. EDV increased 5.0±4.7% in patients with MO-FP, whereas EDV decreased –1.5±3.7% (p=0.001) in patients without MO-FP. No significant difference in percentage change in EDV was observed between patients with and without MO-DE (4.3±5.4% vs. 1.2±5.1%, p=0.139). Univariate regression analysis confirmed that MO-FP predicts LV remodeling (R2=0.354, p=0.001), in contrast to MO-DE (R2=0.086, p=0.139). Infarct size is a better predictor of LV remodeling (R2=0.450, p<0.001) than MO assessed with FP or DE imaging. However, multiple regression analysis showed that the combination of infarct size and MO-FP is the best predictor of LV remodeling (R2=0.528, p<0.001).

MO assessed with FP MRI predicts adverse LV remodeling in patients after AMI, whereas MO determined with DE MRI is not predictive.

Evaluation of FP MRI (to assess microvascular status) and DE MRI (to determine infarct size) may be useful for identification of patients after AMI who are at high risk for LV remodeling.

Roes, S, Kaandorp, T, Bax, J, Van der Wall, E, Lamb, H, De Roos, A, Relationship between Microvascular Obstruction Assessed with First-pass Perfusion or Delayed Contrast-enhanced MRI and Left Ventricular Remodeling in Patients after Acute Myocardial Infarction.  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/4432486.html