Circulation journal : official journal of the Japanese Circulation Society · 2008
Clinical importance of microvascular obstruction on contrast-enhanced MRI in reperfused acute myocardial infarction.
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Nagao Michinobu, Higashino Hiroshi, Matsuoka Hiroshi, Kawakami Hideo, Mochizuki Teruhito, Murase Kenya, Uemura Masahiko, Kouno Tamami
Аннотация
BACKGROUND: The aim of the present study was to investigate the clinical importance of microvascular obstruction (MO) on contrast-enhanced magnetic resonance imaging (MRI), comparing it with the myocardial perfusion index (MPI) assessed using first-pass MRI.
METHODS AND RESULTS: Cardiac MRI was performed in 33 patients within 7 days after reperfusion of a myocardial infarction (MI). Using a bolus injection of Gd-DPTA, first-pass images were obtained with the Turbo-FLASH sequence. Time-intensity curves in the left ventricular cavity and in myocardial sections were generated and then the MPI was assessed by the maximum slope method. Late enhancement (LE) was assessed using the true-FISP sequence. According to the transmurality of LE, the patients were classified into 3 groups: Group 1 included patients with localized endocardial enhancement; Group 2, patients with transmural enhancement; Group 3, patients having LE with MO. In cases of anterior infarction, the MPI for the anterior wall and parts of the inferior wall in Group 3 was significantly lower than that for Group 1 and 2. For inferior infarction, the MPI for parts of the inferior wall in Group 3 was significantly lower than that for Group 1 and 2.
CONCLUSION: MO is related to lower MPI, indicating severe microvascular damage. LE with or without MO is an important marker of perfusion status after reperfused MI.
METHODS AND RESULTS: Cardiac MRI was performed in 33 patients within 7 days after reperfusion of a myocardial infarction (MI). Using a bolus injection of Gd-DPTA, first-pass images were obtained with the Turbo-FLASH sequence. Time-intensity curves in the left ventricular cavity and in myocardial sections were generated and then the MPI was assessed by the maximum slope method. Late enhancement (LE) was assessed using the true-FISP sequence. According to the transmurality of LE, the patients were classified into 3 groups: Group 1 included patients with localized endocardial enhancement; Group 2, patients with transmural enhancement; Group 3, patients having LE with MO. In cases of anterior infarction, the MPI for the anterior wall and parts of the inferior wall in Group 3 was significantly lower than that for Group 1 and 2. For inferior infarction, the MPI for parts of the inferior wall in Group 3 was significantly lower than that for Group 1 and 2.
CONCLUSION: MO is related to lower MPI, indicating severe microvascular damage. LE with or without MO is an important marker of perfusion status after reperfused MI.