Is Functional Improvement after Myocardial Infarction Predicted with Myocardial Enhancement Patterns at Multidetector CT?

Purpose: To prospectively evaluate the sensitivity of myocardial early perfusion defects (EDs) and late enhancement (LE) at multidetector computed tomography (CT) following acute myocardial infarction (AMI) to predict segment myocardial dysfunction and myocardial functional recovery (MFR), by using echocardiography as the reference standard.

Materials and Methods: Institutional review board approval and informed consent were obtained. Twenty-six patients (25 men, one woman; mean age, 53 years ± 9 [standard deviation]), underwent baseline multidetector CT, coronary angiography, and echocardiography within a week of AMI and a follow-up echocardiography at 3 months. ED, LE, and late hypoattenuation were compared with regional left ventricular function and MFR. A logistic regression model and generalized estimating equation analysis were applied to estimate the predictive effect of ED and LE. Differences between groups were evaluated by using nonpaired Student t tests.

Results: All EDs and LE corresponded with AMI location determined by using angiography and echocardiography. For occluded arteries (n = 5), no relationship was found between the presence of ED or LE and MFR. For patent arteries (n = 21), presence of LE had a respective sensitivity and specificity of 73% and 85% for predicting follow-up segment dysfunction, compared with 57% and 90% for ED. In abnormal baseline segments, nonrecovery was clearly related to the presence and size of segment defect area for both ED (odds ratio: 1.95 [95% confidence interval: 0.9, 4.1] per square centimeter) and LE (odds ratio: 1.85 [95% confidence interval: 1.2, 2.9] per square centimeter). Segments that recovered had significantly lower prevalence of ED and LE, and if present, were significantly smaller than in segments remaining abnormal (P < .05).

Conclusion: The presence and size of ED and LE at multidetector CT is closely related to follow-up segment myocardial dysfunction and MFR.

© RSNA, 2007

References

  • 1 Garcia MJ. Could cardiac CT revolutionize the practice of cardiology? Cleve Clin J Med 2005; 72: 88–89. Google Scholar
  • 2 Siemers PT, Higgins CB, Schmidt W, Ashburn W, Hagan P. Detection, quantitation and contrast enhancement of myocardial infarction utilizing computerized axial tomography: comparison with histochemical staining and 99mTc-pyrophosphate imaging. Invest Radiol 1978;13:103–109. Crossref, MedlineGoogle Scholar
  • 3 Doherty PW, Lipton MJ, Berninger WH, Skioldebrand CG, Carlsson E, Redington RW. Detection and quantitation of myocardial infarction in vivo using transmission computed tomography. Circulation 1981;63:597–606. Crossref, MedlineGoogle Scholar
  • 4 Paul JF, Wartski M, Caussin C, et al. Late defect on delayed contrast-enhanced multi–detector row CT scans in the prediction of SPECT infarct size after reperfused acute myocardial infarction: initial experience. Radiology 2005;236:485–489. LinkGoogle Scholar
  • 5 Nikolaou K, Sanz J, Poon M, et al. Assessment of myocardial perfusion and viability from routine contrast-enhanced 16-detector-row computed tomography of the heart: preliminary results. Eur Radiol 2005;15:864–871. Crossref, MedlineGoogle Scholar
  • 6 Mahnken AH, Koos R, Katoh M, et al. Assessment of myocardial viability in reperfused acute myocardial infarction using 16-section computed tomography in comparison to magnetic resonance imaging. J Am Coll Cardiol 2005;45:2042–2047. Crossref, MedlineGoogle Scholar
  • 7 Koyama Y, Matsuoka H, Mochizuki T, et al. Assessment of reperfused acute myocardial infarction with two-phase contrast-enhanced helical CT: prediction of left ventricular function and wall thickness. Radiology 2005;235:804–811. LinkGoogle Scholar
  • 8 Koyama Y, Mochizuki T, Higaki J. Computed tomography assessment of myocardial perfusion, viability, and function. J Magn Reson Imaging 2004;19:800–815. Crossref, MedlineGoogle Scholar
  • 9 Gerber BL, Belge B, Legros GJ, et al. Characterization of acute and chronic myocardial infarcts by multidetector computed tomography: comparison with contrast-enhanced magnetic resonance. Circulation 2006;113:823–833. Crossref, MedlineGoogle Scholar
  • 10 Lardo AC, Cordeiro MA, Silva C, et al. Contrast-enhanced multidetector computed tomography viability imaging after myocardial infarction: characterization of myocyte death, microvascular obstruction, and chronic scar. Circulation 2006;113:394–404. Crossref, MedlineGoogle Scholar
  • 11 Elliott MD, Kim RJ. Late gadolinium cardiovascular magnetic resonance in the assessment of myocardial viability. Coron Artery Dis 2005;16:365–372. Crossref, MedlineGoogle Scholar
  • 12 Bogaert J, Dymarkowski S. Delayed contrast-enhanced MRI: use in myocardial viability assessment and other cardiac pathology. Eur Radiol 2005;15:B52–B58. MedlineGoogle Scholar
  • 13 Kim RJ, Manning WJ. Viability assessment by delayed enhancement cardiovascular magnetic resonance: will low-dose dobutamine dull the shine? Circulation 2004;109:2476–2479. Crossref, MedlineGoogle Scholar
  • 14 Grass M, Manzke R, Nielsen T, et al. Helical cardiac cone beam reconstruction using retrospective ECG gating. Phys Med Biol 2003;48:3069–3084. Crossref, MedlineGoogle Scholar
  • 15 Cerqueira MD, Weissman NJ, Dilsizian V, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 2002;105:539–542. Crossref, MedlineGoogle Scholar
  • 16 Ostrzega E, Maddahi J, Honma H, et al. Quantification of left ventricular myocardial mass in humans by nuclear magnetic resonance imaging. Am Heart J 1989;117:444–452. Crossref, MedlineGoogle Scholar
  • 17 Comparison of invasive and conservative strategies after treatment with intravenous tissue plasminogen activator in acute myocardial infarction: results of the thrombolysis in myocardial infarction (TIMI) phase II trial. The TIMI Study Group. N Engl J Med 1989;320:618–627. Google Scholar
  • 18 Rochitte CE, Lima JA, Bluemke DA, et al. Magnitude and time course of microvascular obstruction and tissue injury after acute myocardial infarction. Circulation 1998;98:1006–1014. Crossref, MedlineGoogle Scholar
  • 19 Newell JD, Mayr W, Gerber KH, Higgins CB. Computerized tomographic (CT) appearance of the myocardium after reversible and irreversible ischemic injury. Invest Radiol 1982;17:544–549. Crossref, MedlineGoogle Scholar
  • 20 Gerber BL, Garot J, Bluemke DA, Wu KC, Lima JA. Accuracy of contrast-enhanced magnetic resonance imaging in predicting improvement of regional myocardial function in patients after acute myocardial infarction. Circulation 2002;106:1083–1089. Crossref, MedlineGoogle Scholar
  • 21 Kaul S, Ito H. Microvasculature in acute myocardial ischemia. I. Evolving concepts in pathophysiology, diagnosis, and treatment. Circulation 2004;109:146–149. Google Scholar
  • 22 Kaul S, Ito H. Microvasculature in acute myocardial ischemia. II. Evolving concepts in pathophysiology, diagnosis, and treatment. Circulation 2004;109:310–315. Google Scholar

Article History

Published in print: 2007