CMR Native T 1 Mapping Allows Differentiation of Reversible Versus Irreversible Myocardial Damage in ST-Segment – Elevation Myocardial Infarction

Content Provider	Semantic Scholar
Author	Borlotti, Alessandra Viliani, Dafne Jerosch-Herold, Michael Alkhalil, Mohammad Maria, Giovanni Luigi De Fahrni, Gregor Dawkins, Sam Wijesurendra, Rohan S. Francis, Jane Ferreira, Vanessa M. Piechnik, Stefan Robson, Matthew D. Banning, Adrian P. Choudhury, Robin Neubauer, Stefan Channon, Keith M. Kharbanda, Rajesh Dall'armellina, Erica
Copyright Year	2017
Abstract	Prognosis after acute myocardial infarction (MI) is primarily dictated by the extent of irreversible myocardial injury and by left ventricular (LV) remodeling. Numerous mechanical, macrovascular, microvascular, and biochemical factors are known to contribute to the early myocardial changes after ischemia reperfusion. Despite the advanced knowledge of the pathophysiology of ischemia reperfusion, the translation of these findings into effective clinical therapies has been limited in the past. Thanks to the continuous technical developments, research has now moved to a new and more complex level: major efforts are being invested in identifying novel advanced cardioprotective strategies aiming to modify the genetic profile and the function of cells involved in the early infarct expansion. The efficacy of such complex and expensive treatments will also depend Background—CMR T1 mapping is a quantitative imaging technique allowing the assessment of myocardial injury early after ST-segment–elevation myocardial infarction. We sought to investigate the ability of acute native T1 mapping to differentiate reversible and irreversible myocardial injury and its predictive value for left ventricular remodeling. Methods and Results—Sixty ST-segment–elevation myocardial infarction patients underwent acute and 6-month 3T CMR, including cine, T2-weighted (T2W) imaging, native shortened modified look-locker inversion recovery T1 mapping, rest first pass perfusion, and late gadolinium enhancement. T1 cutoff values for oedematous versus necrotic myocardium were identified as 1251 ms and 1400 ms, respectively, with prediction accuracy of 96.7% (95% confidence interval, 82.8% to 99.9%). Using the proposed threshold of 1400 ms, the volume of irreversibly damaged tissue was in good agreement with the 6-month late gadolinium enhancement volume (r=0.99) and correlated strongly with the log area under the curve troponin (r=0.80) and strongly with 6-month ejection fraction (r=−0.73). Acute T1 values were a strong predictor of 6-month wall thickening compared with late gadolinium enhancement. Conclusions—Acute native shortened modified look-locker inversion recovery T1 mapping differentiates reversible and irreversible myocardial injury, and it is a strong predictor of left ventricular remodeling in ST-segment–elevation myocardial infarction. A single CMR acquisition of native T1 mapping could potentially represent a fast, safe, and accurate method for early stratification of acute patients in need of more aggressive treatment. Further confirmatory studies will be needed. (Circ Cardiovasc Imaging. 2017;10:e005986. DOI: 10.1161/CIRCIMAGING.116.005986.)
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Alternate Webpage(s)	http://circimaging.ahajournals.org/content/circcvim/10/8/e005986.full.pdf?download=true
Language	English
Access Restriction	Open
Content Type	Text
Resource Type	Article