Author + information
- Received September 17, 2015
- Revision received June 27, 2016
- Accepted June 30, 2016
- Published online September 4, 2017.
- Ananth Kidambi, BMBCh, PhDa,
- Manish Motwani, MBChBa,
- Akhlaque Uddin, MBChBa,
- David P. Ripley, MBChBa,
- Adam K. McDiarmid, MBChBa,
- Peter P. Swoboda, MBChBa,
- David A. Broadbent, MSca,b,
- Tarique Al Musa, MBChBa,
- Bara Erhayiem, MBChBa,
- Joshua Leader, BSca,
- Pierre Croisille, MD, PhDc,
- Patrick Clarysse, MScc,
- John P. Greenwood, MBChB, PhDa and
- Sven Plein, MD, PhDa,∗ ()
- aMultidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
- bDepartment of Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- cUniversité Lyon, INSA Lyon, Université Lyon 1, Université Jean Monnet, CNRS 5220, INSERM 1046, CHU Saint-Etienne, CREATIS, F-69621, Lyon, France
- ↵∗Address for correspondence:
Prof. Sven Plein, Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS2 9JT, United Kingdom.
Objectives In the setting of reperfused acute myocardial infarction (AMI), the authors sought to compare prediction of contractile recovery by infarct extracellular volume (ECV), as measured by T1-mapping cardiac magnetic resonance (CMR), with late gadolinium enhancement (LGE) transmural extent.
Background The transmural extent of myocardial infarction as assessed by LGE CMR is a strong predictor of functional recovery, but accuracy of the technique may be reduced in AMI. ECV mapping by CMR can provide a continuous measure associated with the severity of tissue damage within infarcted myocardium.
Methods Thirty-nine patients underwent acute (day 2) and convalescent (3 months) CMR scans following AMI. Cine imaging, tissue tagging, T2-weighted imaging, modified Look-Locker inversion T1 mapping natively and 15 min post–gadolinium-contrast administration, and LGE imaging were performed. The ability of acute infarct ECV and acute transmural extent of LGE to predict convalescent wall motion, ejection fraction (EF), and strain were compared per-segment and per-patient.
Results Per-segment, acute ECV and LGE transmural extent were associated with convalescent wall motion score (p < 0.01; p < 0.01, respectively). ECV had higher accuracy than LGE extent to predict improved wall motion (area under receiver-operating characteristics curve 0.77 vs. 0.66; p = 0.02). Infarct ECV ≤0.5 had sensitivity 81% and specificity 65% for prediction of improvement in segmental function; LGE transmural extent ≤0.5 had sensitivity 61% and specificity 71%. Per-patient, ECV and LGE correlated with convalescent wall motion score (r = 0.45; p < 0.01; r = 0.41; p = 0.02, respectively) and convalescent EF (p < 0.01; p = 0.04). ECV and LGE extent were not significantly correlated (r = 0.34; p = 0.07). In multivariable linear regression analysis, acute infarct ECV was independently associated with convalescent infarct strain and EF (p = 0.03; p = 0.04), whereas LGE was not (p = 0.29; p = 0.24).
Conclusions Acute infarct ECV in reperfused AMI can complement LGE assessment as an additional predictor of regional and global LV functional recovery that is independent of transmural extent of infarction.
This work was supported by the British Heart Foundation (FS/10/62/28409 to Prof. Plein). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 17, 2015.
- Revision received June 27, 2016.
- Accepted June 30, 2016.
- 2017 American College of Cardiology Foundation