This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ibrahim, T. Articles by Botnar, R. M. Search for Related Content PubMed Articles by Ibrahim, T. Articles by Botnar, R. M. Related Collections Related Article

Serial Contrast-Enhanced Cardiac Magnetic Resonance Imaging Demonstrates Regression of Hyperenhancement Within the Coronary Artery Wall in Patients After Acute Myocardial Infarction

Tareq Ibrahim, MD^_*, Markus R. Makowski, MD, Antanas Jankauskas, MD, David Maintz, MD, Martin Karch, MD^_*, Sylvia Schachoff, RT, Warren J. Manning, MD, Albert Schömig, MD^_*, Markus Schwaiger, MD, Rene M. Botnar, PhD^,_*

^_* Deutsches Herzzentrum München and 1. Medizinische Klinik des Klinikums Rechts der Isar, Technische Universität München, München, Germany
Nuklearmedizinische Klinik und Poliklinik der Technischen Universität München, München, Germany
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
Radiologische Klinik, Universität Münster, Münster, Germany

^_* Reprint requests and correspondence: Rene M. Botnar, PhD, Division of Imaging Sciences, King's College London, 4th Floor, Lambeth Wing, St. Thomas' Hospital, London SE1 7EH, United Kingdom (Email: rene.botnar{at}kcl.ac.uk).

Objectives: Our aim was to determine whether serial contrast-enhanced cardiac magnetic resonance (CE-CMR) is useful for the characterization of tissue signal changes within the coronary vessel wall in patients after acute myocardial infarction (AMI).

Background: Inflammation plays a key role in the development of AMI. CE-CMR of the vessel wall has been found useful for the characterization of inflammatory tissue signal changes in patients with carotid artery stenosis, giant cell arteritis, or Takayasu's arteritis; however, it has never been serially performed in the coronary artery wall in patients with acute and chronic myocardial infarction using a gadolinium-based contrast medium and compared with systemic markers of inflammation.

Methods: CE-CMR using a T1-weighted 3-dimensional gradient echo inversion recovery sequence of the coronary artery wall and 0.2 mmol/kg of gadolinium-diethylenetriaminepentaacetic acid was performed in 10 patients with AMI 6 days and 3 months after coronary intervention and in 9 subjects without coronary artery disease on invasive coronary angiography. Contrast-to-noise ratio (CNR) within the coronary artery wall was quantified in comparison with blood signal.

Results: Patients with AMI demonstrated a significantly increased coronary vessel wall enhancement 6 days after infarction compared with normal subjects (CNR 7.8 ± 4.4 vs. 5.3 ± 3.2, p < 0.001). Three months after infarction, CNR decreased to 6.5 ± 4.7 (p < 0.03). This decrease paralleled declines in C-reactive protein. Angiographically normal segments showed no contrast changes, but CNR significantly decreased in stenotic segments, from 10.9 ± 3.8 to 6.8 ± 5.0 (p < 0.002), resulting in a reduction of enhanced segments from 70% to 25% (p < 0.01).

Conclusions: Serial CE-CMR identified changes in spatial extent and intensity of coronary contrast enhancement in patients after AMI. This technique may be useful for the characterization of transient coronary tissue signal changes, which may represent edema or inflammation during the post-infarction phase. In addition, CE-CMR may offer the potential for visualization of inflammatory activity in atherosclerosis associated with acute coronary syndromes.

Key Words: cardiac magnetic resonance • late enhancement • coronary artery • acute myocardial infarction

Abbreviations and Acronyms   ACS = acute coronary syndromes   AMI = acute myocardial infarction   CAD = coronary artery disease   CE-CMR = contrast-enhanced cardiac magnetic resonance   CRP = C-reactive protein   LCA = left coronary artery   LCX = left circumflex artery   SI = signal intensity

Related Article

Can Contrast-Enhanced Cardiac Magnetic Resonance Assess Inflammation of the Coronary Wall?

Debiao Li, Zahi A. Fayad, and David A. Bluemke
J. Am. Coll. Cardiol. Img. 2009 2: 589-591. [Full Text] [PDF]

This article has been cited by other articles:

				J. Sanz, P. R. Moreno, and V. Fuster The Year in Atherothrombosis J. Am. Coll. Cardiol., April 6, 2010; 55(14): 1487 - 1498. [Full Text] [PDF]

				C. M. Kramer and J. Narula Atherosclerotic Plaque Imaging: The Last Frontier for Cardiac Magnetic Resonance J. Am. Coll. Cardiol. Img., July 1, 2009; 2(7): 916 - 918. [Full Text] [PDF]

				D. Li, Z. A. Fayad, and D. A. Bluemke Can contrast-enhanced cardiac magnetic resonance assess inflammation of the coronary wall? J. Am. Coll. Cardiol. Img., May 1, 2009; 2(5): 589 - 591. [Full Text] [PDF]