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The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction.

Publication ,  Journal Article
Kim, RJ; Wu, E; Rafael, A; Chen, EL; Parker, MA; Simonetti, O; Klocke, FJ; Bonow, RO; Judd, RM
Published in: N Engl J Med
November 16, 2000

BACKGROUND: Recent studies indicate that magnetic resonance imaging (MRI) after the administration of contrast material can be used to distinguish between reversible and irreversible myocardial ischemic injury regardless of the extent of wall motion or the age of the infarct. We hypothesized that the results of contrast-enhanced MRI can be used to predict whether regions of abnormal ventricular contraction will improve after revascularization in patients with coronary artery disease. METHODS: Gadolinium-enhanced MRI was performed in 50 patients with ventricular dysfunction before they underwent surgical or percutaneous revascularization. The transmural extent of hyperenhanced regions was postulated to represent the transmural extent of nonviable myocardium. The extent of regional contractility at the same locations was determined by cine MRI before and after revascularization in 41 patients. RESULTS: Contrast-enhanced MRI showed hyperenhancement of myocardial tissue in 40 of 50 patients before revascularization. In all patients with hyperenhancement the difference in image intensity between hyperenhanced regions and regions without hyperenhancement was more than 6 SD. Before revascularization, 804 of the 2093 myocardial segments analyzed (38 percent) had abnormal contractility, and 694 segments (33 percent) had some areas of hyperenhancement. In an analysis of all 804 dysfunctional segments, the likelihood of improvement in regional contractility after revascularization decreased progressively as the transmural extent of hyperenhancement before revascularization increased (P<0.001). For instance, contractility increased in 256 of 329 segments (78 percent) with no hyperenhancement before revascularization, but in only 1 of 58 segments with hyperenhancement of more than 75 percent of tissue. The percentage of the left ventricle that was both dysfunctional and not hyperenhanced before revascularization was strongly related to the degree of improvement in the global mean wall-motion score (P<0.001) and the ejection fraction (P<0.001) after revascularization. CONCLUSIONS: Reversible myocardial dysfunction can be identified by contrast-enhanced MRI before coronary revascularization.

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Published In

N Engl J Med

DOI

ISSN

0028-4793

Publication Date

November 16, 2000

Volume

343

Issue

20

Start / End Page

1445 / 1453

Location

United States

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Stroke Volume
  • Prospective Studies
  • Prognosis
  • Organometallic Compounds
  • Myocardium
  • Myocardial Revascularization
  • Myocardial Infarction
  • Myocardial Contraction
  • Middle Aged
 

Citation

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Kim, R. J., Wu, E., Rafael, A., Chen, E. L., Parker, M. A., Simonetti, O., … Judd, R. M. (2000). The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. N Engl J Med, 343(20), 1445–1453. https://doi.org/10.1056/NEJM200011163432003
Kim, R. J., E. Wu, A. Rafael, E. L. Chen, M. A. Parker, O. Simonetti, F. J. Klocke, R. O. Bonow, and R. M. Judd. “The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction.N Engl J Med 343, no. 20 (November 16, 2000): 1445–53. https://doi.org/10.1056/NEJM200011163432003.
Kim RJ, Wu E, Rafael A, Chen EL, Parker MA, Simonetti O, et al. The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. N Engl J Med. 2000 Nov 16;343(20):1445–53.
Kim, R. J., et al. “The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction.N Engl J Med, vol. 343, no. 20, Nov. 2000, pp. 1445–53. Pubmed, doi:10.1056/NEJM200011163432003.
Kim RJ, Wu E, Rafael A, Chen EL, Parker MA, Simonetti O, Klocke FJ, Bonow RO, Judd RM. The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. N Engl J Med. 2000 Nov 16;343(20):1445–1453.
Journal cover image

Published In

N Engl J Med

DOI

ISSN

0028-4793

Publication Date

November 16, 2000

Volume

343

Issue

20

Start / End Page

1445 / 1453

Location

United States

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Stroke Volume
  • Prospective Studies
  • Prognosis
  • Organometallic Compounds
  • Myocardium
  • Myocardial Revascularization
  • Myocardial Infarction
  • Myocardial Contraction
  • Middle Aged