Early Gadolinium Enhancement for Determination of Area at Risk: A Preclinical Validation Study

TY - JOUR

T1 - Early Gadolinium Enhancement for Determination of Area at Risk

T2 - A Preclinical Validation Study

AU - Hammer-Hansen, Sophia

AU - Leung, Steve W

AU - Hsu, Li-Yueh

AU - Wilson, Joel R

AU - Taylor, Joni

AU - Greve, Anders M

AU - Thune, Jens Jakob

AU - Køber, Lars

AU - Kellman, Peter

AU - Arai, Andrew E

N1 - Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

PY - 2017/2/1

Y1 - 2017/2/1

N2 - Objectives The aim of this study was to determine whether early gadolinium enhancement (EGE) by cardiac magnetic resonance (CMR) in a canine model of reperfused myocardial infarction depicts the area at risk (AAR) as determined by microsphere blood flow analysis. Background It remains controversial whether only the irreversibly injured myocardium enhances when CMR is performed in the setting of acute myocardial infarction. Recently, EGE has been proposed as a measure of the AAR in acute myocardial infarction because it correlates well with T2-weighted imaging of the AAR, but this still requires pathological validation. Methods Eleven dogs underwent 2 h of coronary artery occlusion and 48 h of reperfusion before imaging at 1.5-T. EGE imaging was performed 3 min after contrast administration with coverage of the entire left ventricle. Late gadolinium enhancement imaging was performed between 10 and 15 min after contrast injection. AAR was defined as myocardium with blood flow <2 SD from remote myocardium determined by microspheres during occlusion. The size of infarction was determined with triphenyltetrazolium chloride. Results There was no significant difference in the size of enhancement by EGE compared with the size of AAR by microspheres (44.1 ± 15.8% vs. 42.7 ± 9.2%; p = 0.61), with good correlation (r = 0.88; p < 0.001) and good agreement by Bland-Altman analysis (mean bias 1.4 ± 17.4%). There was no difference in the size of enhancement by EGE compared with enhancement on native T1 and T2 maps. The size of EGE was significantly greater than the infarct by triphenyltetrazolium chloride (44.1 ± 15.8% vs. 20.7 ± 14.4%; p < 0.001) and late gadolinium enhancement (44.1 ± 15.8% vs. 23.5 ± 12.7%; p < 0.001). Conclusions At 3 min post-contrast, EGE correlated well with the AAR by microspheres and CMR and was greater than infarct size. Thus, EGE enhances both reversibly and irreversibly injured myocardium.

AB - Objectives The aim of this study was to determine whether early gadolinium enhancement (EGE) by cardiac magnetic resonance (CMR) in a canine model of reperfused myocardial infarction depicts the area at risk (AAR) as determined by microsphere blood flow analysis. Background It remains controversial whether only the irreversibly injured myocardium enhances when CMR is performed in the setting of acute myocardial infarction. Recently, EGE has been proposed as a measure of the AAR in acute myocardial infarction because it correlates well with T2-weighted imaging of the AAR, but this still requires pathological validation. Methods Eleven dogs underwent 2 h of coronary artery occlusion and 48 h of reperfusion before imaging at 1.5-T. EGE imaging was performed 3 min after contrast administration with coverage of the entire left ventricle. Late gadolinium enhancement imaging was performed between 10 and 15 min after contrast injection. AAR was defined as myocardium with blood flow <2 SD from remote myocardium determined by microspheres during occlusion. The size of infarction was determined with triphenyltetrazolium chloride. Results There was no significant difference in the size of enhancement by EGE compared with the size of AAR by microspheres (44.1 ± 15.8% vs. 42.7 ± 9.2%; p = 0.61), with good correlation (r = 0.88; p < 0.001) and good agreement by Bland-Altman analysis (mean bias 1.4 ± 17.4%). There was no difference in the size of enhancement by EGE compared with enhancement on native T1 and T2 maps. The size of EGE was significantly greater than the infarct by triphenyltetrazolium chloride (44.1 ± 15.8% vs. 20.7 ± 14.4%; p < 0.001) and late gadolinium enhancement (44.1 ± 15.8% vs. 23.5 ± 12.7%; p < 0.001). Conclusions At 3 min post-contrast, EGE correlated well with the AAR by microspheres and CMR and was greater than infarct size. Thus, EGE enhances both reversibly and irreversibly injured myocardium.

KW - Animals

KW - Blood Flow Velocity

KW - Contrast Media/administration & dosage

KW - Coronary Circulation

KW - Disease Models, Animal

KW - Dogs

KW - Fluorescent Dyes/administration & dosage

KW - Gadolinium DTPA/administration & dosage

KW - Magnetic Resonance Imaging

KW - Microspheres

KW - Myocardial Infarction/diagnostic imaging

KW - Myocardial Perfusion Imaging/methods

KW - Myocardial Reperfusion Injury/diagnostic imaging

KW - Myocardium/pathology

KW - Predictive Value of Tests

KW - Time Factors

KW - Tissue Survival

U2 - 10.1016/j.jcmg.2016.04.009

DO - 10.1016/j.jcmg.2016.04.009

M3 - Journal article

C2 - 27665165

SN - 1936-878X

VL - 10

SP - 130

EP - 139

JO - J A C C: Cardiovascular Imaging

JF - J A C C: Cardiovascular Imaging

IS - 2

ER -