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Assessment of the myocardial area at risk: comparing T2-weighted cardiovascular magnetic resonance imaging with contrast-enhanced cine (CE-SSFP) imaging-a DANAMI3 substudy

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Aims: Myocardial salvage following treatment for ST-segment elevation myocardial infarction is prognostic for morbidity and mortality. Studies with myocardial salvage as endpoint rely on valid assessment of the myocardial area at risk (AAR). T2-weighted cardiovascular magnetic resonance (CMR) imaging is the preferred method to assess the AAR. However, T2-weighted imaging can be of poor image quality and uninterpretable. Contrast-enhanced (CE) cine imaging can also show AAR and our aim was to investigate if CE-cine can replace T2-weighted imaging. Cine imaging is part of a standard CMR-protocol and implementing CE-cine imaging for assessment of the AAR would mean shorter investigation time.

Methods and results: As a DANAMI-3 substudy, we performed successful dual imaging of the AAR in 166 participants using both T2-weighted short tau inversion recovery (T2-STIR) and CE-cine imaging. T2-STIR imaging was non-diagnostic in nine and CE-cine in one scan during the period. CE-cine measured 4.7% of left ventricle (LV) [95% confidence interval 3.2-6.2%] smaller AAR compared with T2-STIR images (P < 0.001). Visual analysis of a plot of infarct size vs. AAR showed an overestimation of the AAR when measured with T2-STIR images. There was no difference in AAR with CE-cine in an interobserver analysis of 46 scans [1.2 g (standard deviation 9.5), P = 0.42].

Conclusions: CE-cine imaging shows good internal consistency in assessment of the AAR. A visual inspection reveals possible overestimation of AAR with T2-STIR images. There is good interobserver agreement in the analysis of CE-cine imaging. CE-cine can replace T2-STIR imaging resulting in a more valid assessment of the myocardial AAR.

Original languageEnglish
JournalEuropean heart journal cardiovascular Imaging
Volume20
Issue number3
Pages (from-to)361-366
Number of pages6
ISSN1525-2167
DOIs
Publication statusPublished - 1 Mar 2019

Bibliographical note

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: journals.permissions@oup.com.

    Research areas

  • Acute myocardial infarction, Area at risk, Cardiovascular magnetic resonance imaging, Severity of Illness Index, Prognosis, Risk Assessment, Humans, Middle Aged, Image Interpretation, Computer-Assisted, Magnetic Resonance Imaging/methods, Male, ST Elevation Myocardial Infarction/diagnostic imaging, Survival Rate, Treatment Outcome, Edema, Cardiac/diagnostic imaging, Magnetic Resonance Imaging, Cine/methods, Angioplasty, Balloon, Coronary/methods, Contrast Media, Female, Aged, Observer Variation

ID: 56240494