Recovery of regional myocardial function and myocardial oedema following reperfused acute myocardial infarction
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Recovery of regional myocardial function and myocardial oedema following reperfused acute myocardial infarction Ananth Kidambi1*, Adam N Mather2,1, Peter Swoboda1, Manish Motwani1, Timothy Fairbairn1, John P Greenwood1, Sven Plein1 From 15th Annual SCMR Scientific Sessions Orlando, FL, USA. 2-5 February 2012 Summary We investigated the relationship between myocardial oedema and recovery of regional myocardial function in patients with acute reperfused myocardial infarction (MI). Early after acute MI, oedema in the peri-infarct zone, as delineated by T2 weighted (T2w) cardiovascular magnetic resonance (CMR) imaging, demonstrated significantly reduced strain as compared to remote myocardium. The recovery of regional function in the peri-infarct zone closely followed the resolution of hyperenhancement on T2w CMR. In addition, both transmural and subendocardial infarcts showed a degree of functional recovery after acute MI. Background Myocardial tissue oedema is a feature of acute reperfused myocardial infarction, and contributes to stunning of viable peri-infarct myocardium (the ‘area at risk’). Regression of oedema on T2w CMR imaging is related to improved myocardial contractility post MI in animal models. Whether a similar relationship between myocardial oedema and regional myocardial function exists in man is not currently known. We hypothesised that the resolution of tissue oedema correlates with recovery of regional contractile function. Methods We studied patients after primary percutaneous coronary intervention for first ST-elevation MI. Patients underwent CMR with T2w, myocardial tagging and late 1 Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, UK Full list of author information is available at the end of the article
gadolinium enhancement imaging at median 2, 30 and 90 days post reperfusion. Infarct size, regional circumferential strain, intensity and volume of myocardial oedema were measured for infarct zone, peri-infarct zone (area at risk) and remote myocardium. Oedema and infarction were defined as zones with signal intensity 2 standard deviations above remote myocardium in T2w and LGE imaging respectively. T2w signal intensity was corrected using a ratio to remote myocardium.
Results Thirty patients had CMR imaging at all three time points and had adequate image quality with sufficient peri-infarct oedema for quantitative analysis. Circumferential strain was significantly diminished in infarct and peri-infarct zones compared to remote myocardium (means -0.149 vs. -0.184 vs. -0.236, P
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