Karl Friedrich Kreitner MD, Presenter: Nothing to Disclose

Nico Abegunewardene MD, Abstract Co-Author: Nothing to Disclose

Katja Oberholzer MD, Abstract Co-Author: Nothing to Disclose

Stefan Weber, Abstract Co-Author: Nothing to Disclose

Georg Horstick, Abstract Co-Author: Nothing to Disclose

Christoph Dueber MD, Abstract Co-Author: Nothing to Disclose

to determine the best time point for detection of microvascular obstruction (MVO) and late enhancement areas (LE) in patients with acute myocardial infarction (AMI) and to evaluate which CMR imaging technique best predicts left ventricular remodeling after one year.

40 patients (4 female, 36 male, mean age 53 years) with first acute MI and successful recanalization (acute stent-PTCA) underwent 4 cine CMR examinations, the first within 48 hours after AMI, then at 9 days, at 6 months and at one year. For assessment of LE and MO, we used and inversion prepared 2D and 3D segmented TurboFlash sequence after determination of optimal TI in short-axis orientation of the heart. LE and MO were measured 2 (early enhancement) and 10 minutes (late enhancement) after application of 0.2 mmol Gd-DTPA /kg body weight. The left ventricle (LV) was further assessed planimetrically.  

Areas of MO were detected in 31/40 early and in 27/40 late after contrast application at exam 1. The number decreased at exam 2 to 22/40 and 16/40 patients, respectively (p < 0.001). MO areas significantly decreased from 5.4 to 3.0 % between early and late enhancement (p < 0.001) at exam 1, and from 5.4 to 2.8 at early enhancement (p < 0.001), and from 3.0 to 1.2 at late enhancement (p < 0.001) between exam 1 and 2, respectively. Areas of LE decreased within 10 days between exam 1 and 2 from 20.4 +/- 10.1% to 16.3 +/- 8.9% (p < 0.001). Areas of LE at exam 1 was the strongest predictor of change in LV ejection fraction and end-systolic volumes (r = -0.742, r = EF and r = 0.628, p < 0.001, respectively).

The real extent of MO is best assessed on images obtained 2 minutes after contrast application and within 24-48 after acute MI. It offers the best discrimination regarding the development of ESV and EF.The best prognostic marker of LV remodeling proved to be the area of LE determined within the first 48 hours after AMI.

For assessment of prognostic parameters, cardiac magnetic resonance imaging should prefereably be done within 48 hours after acute myocardial infarction.

Kreitner, K, Abegunewardene, N, Oberholzer, K, Weber, S, Horstick, G, Dueber, C, Assessment of Microvascular Obstruction and Prediction of Long-term Remodeling after Acute Myocardial Infarction: Cardiac MR (CMR) Imaging Study.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9005960.html