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Previous Volume 343:1445-1453 November 16, 2000 Number 20 Next

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ABSTRACT

Background Recent studies indicate that magnetic resonance imaging (MRI) after the administration of contrast material can be used to distinguish between reversible and irreversible myocardial ischemic injury regardless of the extent of wall motion or the age of the infarct. We hypothesized that the results of contrast-enhanced MRI can be used to predict whether regions of abnormal ventricular contraction will improve after revascularization in patients with coronary artery disease.

Methods Gadolinium-enhanced MRI was performed in 50 patients with ventricular dysfunction before they underwent surgical or percutaneous revascularization. The transmural extent of hyperenhanced regions was postulated to represent the transmural extent of nonviable myocardium. The extent of regional contractility at the same locations was determined by cine MRI before and after revascularization in 41 patients.

Results Contrast-enhanced MRI showed hyperenhancement of myocardial tissue in 40 of 50 patients before revascularization. In all patients with hyperenhancement the difference in image intensity between hyperenhanced regions and regions without hyperenhancement was more than 6 SD. Before revascularization, 804 of the 2093 myocardial segments analyzed (38 percent) had abnormal contractility, and 694 segments (33 percent) had some areas of hyperenhancement. In an analysis of all 804 dysfunctional segments, the likelihood of improvement in regional contractility after revascularization decreased progressively as the transmural extent of hyperenhancement before revascularization increased (P<0.001). For instance, contractility increased in 256 of 329 segments (78 percent) with no hyperenhancement before revascularization, but in only 1 of 58 segments with hyperenhancement of more than 75 percent of tissue. The percentage of the left ventricle that was both dysfunctional and not hyperenhanced before revascularization was strongly related to the degree of improvement in the global mean wall-motion score (P<0.001) and the ejection fraction (P<0.001) after revascularization.

Conclusions Reversible myocardial dysfunction can be identified by contrast-enhanced MRI before coronary revascularization.

Source Information

From the Feinberg Cardiovascular Research Institute (R.J.K., E.-L.C., M.A.P., F.J.K., R.O.B., R.M.J.) and the Departments of Medicine (R.J.K., E.W., A.R., M.A.P., F.J.K., R.O.B., R.M.J.) and Biomedical Engineering (R.M.J.), Northwestern University Medical School; and Siemens Medical Systems (O.S.) — both in Chicago.

Address reprint requests to Dr. Kim at the Feinberg Cardiovascular Research Institute, Northwestern University Medical School, 303 E. Chicago Ave., Tarry 12-733, Chicago, IL 60611-3008 or at r-kim4{at}northwestern.edu.

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