Peri-Infarct Zone on Early Contrast-Enhanced CMR Imaging in Patients With Acute Myocardial Infarction

OBJECTIVES The aims of this study were to evaluate hyperenhanced regions on contrastenhanced cardiovascular magnetic resonance (CE-CMR) imaging in patients with acute myocardial infarction (AMI) between early contrast-enhanced cardiovascular magnetic resonance (ECE) (2 min) and late contrast-enhanced cardiovascular magnetic resonance (LCE) (10 to 15 min) after gadolinium administration, and to compare the CE-CMR images with area at risk (AAR) derived from T2-weighted (T2W) CMR. BACKGROUND Although CE-CMR imaging can demarcate the infarcted myocardium, the value of hyperenhancement in AMI is still in dispute. The size of hyperenhanced regions may vary with time, and overestimation can be often observed with early acquisition. METHODS Thirty-four patients with successfully reperfused AMI underwent CMR within 4 days after the event. Myocardial regions as percentage of left ventricular (LV) myocardium were quantified on CE and T2W images. Relative peri-infarct zone was calculated as the difference in hyperenhanced regions between ECE and LCE, normalized to the individual infarct size. RESULTS Both ECE and LCE images revealed hyperenhancement in the territory of the infarct-related artery in all patients. The hyperenhanced region on ECE extended transmurally and was consistently larger than that on LCE (39 +/- 12% vs. 27 +/- 12% of LV myocardium, p < 0.001). The relative peri-infarct zone was inversely correlated with the transmurality of infarction (r = -0.59, p < 0.001) and the time from symptom to reperfusion (r = -0.46, p < 0.01). The hyperenhanced region on ECE was correlated with the T2W CMR-derived AAR (r = 0.86, p < 0.001) with the average difference of -0.8% and the limits of agreement of +/- 11.9%. CONCLUSIONS ECE depicts ischemically injured but salvaged myocardium, as well as infarcted myocardium in patients with AMI. The myocardium at risk and infarcted myocardium after reperfusion can be retrospectively assessed by the combination of ECE and LCE. (J Am Coll Cardiol Img 2011; 4: 610-8) (C) 2011 by the American College of Cardiology Foundation