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Rapid detection of myocardial infarction by subsecond, free-breathing delayed contrast-enhancement cardiovascular magnetic resonance.

Publication ,  Journal Article
Sievers, B; Elliott, MD; Hurwitz, LM; Albert, TSE; Klem, I; Rehwald, WG; Parker, MA; Judd, RM; Kim, RJ
Published in: Circulation
January 16, 2007

BACKGROUND: An ultrafast, delayed contrast-enhancement cardiovascular magnetic resonance technique that can acquire subsecond, "snapshot" images during free breathing (subsecond) is becoming widely available. This technique provides myocardial infarction (MI) imaging with complete left ventricular coverage in < 30 seconds. However, the accuracy of this technique is unknown. METHODS AND RESULTS: We prospectively compared subsecond imaging with routine breath-hold delayed contrast-enhancement cardiovascular magnetic resonance (standard) in consecutive patients. Two cohorts with unambiguous standards of truth were prespecified: (1) patients with documented prior MI (n=135) and (2) patients without MI and with low likelihood of coronary disease (lowest Framingham risk category; n=103). Scans were scored masked to identity and clinical information. Sensitivity, specificity, and accuracy of subsecond imaging for MI diagnosis were 87%, 96%, and 91%, respectively. Compared with the standard technique (98%, 100%, 99%), the subsecond technique had modestly reduced sensitivity (P=0.0001), but specificity was excellent. Missed infarcts were generally small or subendocardial (87%). Overall, regional transmural extent of infarction scores were highly concordant (2083/2294; 91%); however, 51 of 337 regions (15%) considered predominantly infarcted (> 50% transmural extent of infarction) by the standard technique were considered viable (< or = 25% transmural extent of infarction) by the subsecond technique. Quantitative analysis demonstrated moderately reduced contrast-to-noise ratios for subsecond imaging between infarct and remote myocardium (12.0+/-7.2 versus 20.1+/-6.6; P<0.0001) and infarct and left ventricular cavity (-2.5+/-2.7 versus 3.6+/-3.7; P<0.0001). CONCLUSIONS: MI can be rapidly detected by subsecond delayed contrast-enhancement cardiovascular magnetic resonance during free breathing with high accuracy. This technique could be considered the preferred approach in patients who are more acutely ill or unable to hold their breath. However, compared with standard imaging, sensitivity is mildly reduced, and the transmural extent of infarction may be underestimated.

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Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

January 16, 2007

Volume

115

Issue

2

Start / End Page

236 / 244

Location

United States

Related Subject Headings

  • Time Factors
  • Respiratory Mechanics
  • Respiration
  • Radiography
  • Prospective Studies
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Magnetic Resonance Imaging
  • Humans
 

Citation

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Sievers, B., Elliott, M. D., Hurwitz, L. M., Albert, T. S. E., Klem, I., Rehwald, W. G., … Kim, R. J. (2007). Rapid detection of myocardial infarction by subsecond, free-breathing delayed contrast-enhancement cardiovascular magnetic resonance. Circulation, 115(2), 236–244. https://doi.org/10.1161/CIRCULATIONAHA.106.635409
Sievers, Burkhard, Michael D. Elliott, Lynne M. Hurwitz, Timothy S. E. Albert, Igor Klem, Wolfgang G. Rehwald, Michele A. Parker, Robert M. Judd, and Raymond J. Kim. “Rapid detection of myocardial infarction by subsecond, free-breathing delayed contrast-enhancement cardiovascular magnetic resonance.Circulation 115, no. 2 (January 16, 2007): 236–44. https://doi.org/10.1161/CIRCULATIONAHA.106.635409.
Sievers B, Elliott MD, Hurwitz LM, Albert TSE, Klem I, Rehwald WG, et al. Rapid detection of myocardial infarction by subsecond, free-breathing delayed contrast-enhancement cardiovascular magnetic resonance. Circulation. 2007 Jan 16;115(2):236–44.
Sievers, Burkhard, et al. “Rapid detection of myocardial infarction by subsecond, free-breathing delayed contrast-enhancement cardiovascular magnetic resonance.Circulation, vol. 115, no. 2, Jan. 2007, pp. 236–44. Pubmed, doi:10.1161/CIRCULATIONAHA.106.635409.
Sievers B, Elliott MD, Hurwitz LM, Albert TSE, Klem I, Rehwald WG, Parker MA, Judd RM, Kim RJ. Rapid detection of myocardial infarction by subsecond, free-breathing delayed contrast-enhancement cardiovascular magnetic resonance. Circulation. 2007 Jan 16;115(2):236–244.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

January 16, 2007

Volume

115

Issue

2

Start / End Page

236 / 244

Location

United States

Related Subject Headings

  • Time Factors
  • Respiratory Mechanics
  • Respiration
  • Radiography
  • Prospective Studies
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Magnetic Resonance Imaging
  • Humans