What about CMR in patients with acute MI?

What about CMR in patients What about CMR in patients with acute MI?with acute MI?

• CMR for viability in patients post-AMI CMR for viability in patients post-AMI showed similar findings as compared to showed similar findings as compared to studies of chronic MIstudies of chronic MI

• Regional LV recovery is inversely related Regional LV recovery is inversely related to transmural extent of DHEto transmural extent of DHE

• CMR can also evaluate MVOCMR can also evaluate MVO

Gerber BL, et al. Circulation 2002Gerber BL, et al. Circulation 2002

Acute MIAcute MIInfarct TransmuralityInfarct Transmurality

Wu KC, et al. Circulation 1998;97:765Wu KC, et al. Circulation 1998;97:765

Acute anterior MI post PCI

MVO by MRI predicts significantly MVO by MRI predicts significantly increased rate of CV complications after MIincreased rate of CV complications after MI

Acute MIAcute MIMicrovascular ObstructionMicrovascular Obstruction

MVO with DE-CMRMVO with DE-CMR

Perfusion vs DE-CMR for MVOPerfusion vs DE-CMR for MVO

There is prognostic data for both There is prognostic data for both DHE and MVO in the setting of DHE and MVO in the setting of AMI - which is a more powerful AMI - which is a more powerful

predictor of LV recovery?predictor of LV recovery?

MethodsMethods

• Studied patients presenting with first Studied patients presenting with first acute STEMI treated with primary PCIacute STEMI treated with primary PCI

• Underwent CMR at 3 days and 6 monthsUnderwent CMR at 3 days and 6 months

• MVO and DHE were analyzed on a global MVO and DHE were analyzed on a global and regional level and compared to and regional level and compared to change in regional LVFchange in regional LVF

Shapiro MD, et al. Am J Cardiol 2007;100:211-216Shapiro MD, et al. Am J Cardiol 2007;100:211-216

Relation of degree of transmurality of Relation of degree of transmurality of DHE and MVO at baselineDHE and MVO at baseline

81

36

917

34

19

2

30

72

0

20

40

60

80

100

<50% 51-75% >75%

No MVO MVO <50th percentile MVO >50th percentile


DHE vs MVODHE vs MVOChange in Regional LVFChange in Regional LVF

DHEDHE MVOMVO


• Both degree of DHE and MVO predicted LV recovery at Both degree of DHE and MVO predicted LV recovery at follow-upfollow-up

• Unadjusted OR for any improvement in regional LVF with Unadjusted OR for any improvement in regional LVF with increasing DHE was 0.2 (p<0.001) whereas it was 0.4 increasing DHE was 0.2 (p<0.001) whereas it was 0.4 (p<0.001) with increasing MVO(p<0.001) with increasing MVO

• However, when co-adjusted, the OR for LV recovery However, when co-adjusted, the OR for LV recovery remained for degree of DHE (p<0.0001) but the relation with remained for degree of DHE (p<0.0001) but the relation with MVO was lost (p=0.64)MVO was lost (p=0.64)





Regional LVFRegional LVFDHE and MVODHE and MVO

1 8

5 0

3 9

1 6 1 1

3 0 3 1 3 0

1 3

4 8

5 9

0

2 0

4 0

6 0

8 0

1 0 0

< 5 0 % 5 1 - 7 5 % > 7 5 %

N o r m a l M i l d H y p o k i n e s i a S e v e r e H y p o k i n e s i a A k i n e s i a

17

5 2

32 29

7

3427 26

17

38

65

0

20

40

60

80

100

No MVO MVO<50th percentile MVO>50th percentile

Normal Mild Hypokinesia Severe Hypokinesia Akinesia

52

29

12

3126

5

15

26 29

3

19

53

0

20

40

60

80

100

No MVO MVO<50th percentile MVO>50th percentile


62

21

0

26 28

511

35

23

1

16

72

0

20

40

60

80

100

<50% 51-75% >75%


Baseline Follow-upBaseline Follow-up


• Both degree of DHE and MVO predicted LV recovery at Both degree of DHE and MVO predicted LV recovery at follow-upfollow-up

• All segments with >75% transmurality of DHE were All segments with >75% transmurality of DHE were akinetic at follow-upakinetic at follow-up

• Although only 18% of segments with <50% transmurality Although only 18% of segments with <50% transmurality had normal function at baseline, 62% recovered function had normal function at baseline, 62% recovered function at follow-up (only 1% demonstrated akinesia)at follow-up (only 1% demonstrated akinesia)

• Correlations with MVO were similarCorrelations with MVO were similar

Regional LVFRegional LVFDHE and MVODHE and MVO


• Moderate correlation between size MVO on FP and DHE Moderate correlation between size MVO on FP and DHE imaging (R=0.78)imaging (R=0.78)

• Size of hypoenhanced area observed on FP larger than Size of hypoenhanced area observed on FP larger than DHE DHE – 10.6 ± 6.3 g vs 4.2 ± 2.8 g10.6 ± 6.3 g vs 4.2 ± 2.8 g

• There was a decrease but persistent area of There was a decrease but persistent area of hypoenhancement on DHE imaging on f/u scanshypoenhancement on DHE imaging on f/u scans– 4.4 ± 1.8 g vs 0 g4.4 ± 1.8 g vs 0 g

• These 2 observations suggest that PD seen on FP These 2 observations suggest that PD seen on FP represents more than just MVO and that area of represents more than just MVO and that area of hypoenhancement on DHE probably represents a more hypoenhancement on DHE probably represents a more accurate measure of MVOaccurate measure of MVO



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What about CMR in patients with acute MI?