Early Assessment of Myocardial Viability by the Use of Delayed Enhancement Computed Tomography After Primary Percutaneous Coronary Intervention
Gastón A. Rodriguez-Granillo, MD, PhD*, ,*,
Miguel A. Rosales, MD*,
Santiago Baum, MD ,
Paola Rennes, MD,
Carlos Rodriguez-Pagani, MD,
Valeria Curotto, MD,
Carlos Fernandez-Pereira, MD ,
Claudio Llaurado, BSc,
Gustavo Risau, MD,
Elina Degrossi, MD*,
Hernán C. Doval, MD, PhD,
Alfredo E. Rodriguez, MD, PhD*,
* Department of Cardiovascular Imaging, Otamendi Hospital, Buenos Aires, Argentina
Department of Cardiology, Otamendi Hospital, Buenos Aires, Argentina
Department of Interventional Cardiology, Otamendi Hospital, Buenos Aires, Argentina
Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
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Figure 1 Patterns of Delayed Enhancement
(A) Subendocardial (arrowheads) DE detected 29 min after last contrast injection (total 250 ml) in a 66-year-old man. Door-to-balloon time and lesion crossing time were 60 min and 16 min, respectively. After primary PCI, electrocardiographic ST-segment resolution was >50%, with TIMI flow grade 3 and TMPG 3. (B) Transmural (arrows) extension of myocardium DE (17 min after last contrast injection, total 300 ml) in the left circumflex territory of a 53 year-old man. Door-to-balloon time and lesion crossing time were 45 min and 16 min, respectively. After primary PCI, electrocardiographic ST-segment resolution was <50%, with TIMI flow grade 3 and TMPG 0. DE = delayed enhancement; PCI = percutaneous coronary intervention; TIMI = Thrombolysis In Myocardial Infarction; TMPG = Thrombolysis In Myocardial Infarction myocardial perfusion grade.
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Figure 2 Myocardial Delayed Enhancement in a Patient With Failed Microvascular Reperfusion
Anterior wall ST-segment acute myocardial infarction in a 55-year-old man without pre-infarction angina who underwent primary PCI with stent implantation in the proximal left anterior descending artery. A post-procedural TIMI flow grade 3 was achieved with TMPG 0. Electrocardiographic ST-segment resolution was <50%, and peak creatine kinase was 4,432 U/l. Noncontrast multidetector computed tomography performed 30 min after the last contrast injection (total volume 250 ml) detected extensive transmural delayed-enhancement myocardium in the anterior LV wall. The top panel shows the vertical long axis (left) and 3-chamber views, whereas the short axis from base to apex (A to D) are displayed below. Ao = aorta; LA = left atrium; LV = left ventricle; RCA = right coronary artery; RV = right ventricle; other abbreviations as in Figure 1.
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Figure 3 Relationship Between Creatine Kinase Levels and the Extent of Delayed Enhancement
A significant positive correlation (Spearman correlation coefficient) between peak creatine kinase levels and the number of segments with delayed enhancement is shown (r = 0.57, p < 0.001).
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Figure 4 Absence of Delayed-Enhancement in a Patient With Successful Reperfusion
Short-axis (A), horizontal long-view (4-chamber) (B), and vertical long-view (2-chamber) (C) in a 50- year-old female patient with pre-infarction angina and an inferior ST-segment acute myocardial infarction (note stent in the mid RCA of B). Scan was performed 16 min after the last contrast injection (total volume 250 ml). The TIMI and TMPG obtained after primary PCI were of grade 3. No delayed enhancement was detected in the myocardium. Abbreviations as in Figure 2.
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