Contrast-enhanced multidetector computed tomography viability imaging after myocardial infarction: Characterization of myocyte death, microvascular obstruction, and chronic scar

Albert C. Lardo, Marco A S Cordeiro, Caterina Silva, Luciano C. Amado, Richard T. George, Anastasios P. Saliaris, Karl H. Schuleri, Veronica R. Fernandes, Menekhem Zviman, Saman Nazarian, Henry R Halperin, Katherine Chih-Ching Wu, Joshua M. Hare, Joao Lima

Research output: Contribution to journalArticle

Abstract

BACKGROUND-: The ability to distinguish dysfunctional but viable myocardium from nonviable tissue has important prognostic implications after myocardial infarction. The purpose of this study was to validate the accuracy of contrast-enhanced multidetector computed tomography (MDCT) for quantifying myocardial necrosis, microvascular obstruction, and chronic scar after occlusion/reperfusion myocardial infarction. METHODS AND RESULTS-: Ten dogs and 7 pigs underwent balloon occlusion of the left anterior descending coronary artery (LAD) followed by reperfusion. Contrast-enhanced (Visipaque, 150 mL, 325 mg/mL) MDCT (0.5 mm x 32 slice) was performed before occlusion and 90 minutes (canine) or 8 weeks (porcine) after reperfusion. MDCT images were analyzed to define infarct size/extent and microvascular obstruction and compared with postmortem myocardial staining (triphenyltetrazolium chloride) and microsphere blood flow measurements. Acute and chronic infarcts by MDCT were characterized by hyperenhancement, whereas regions of microvascular obstruction were characterized by hypoenhancement. MDCT infarct volume compared well with triphenyltetrazolium chloride staining (acute infarcts 21.1±7.2% versus 20.4±7.4%, mean difference 0.7%; chronic infarcts 4.15±1.93% versus 4.92±2.06%, mean difference 0.76%) and accurately reflected morphology and the transmural extent of injury in all animals. Peak hyperenhancement of infarcted regions occurred ≈5 minutes after contrast injection. MDCT-derived regions of microvascular obstruction were also identified accurately in acute studies and correlated with reduced flow regions as measured by microsphere blood flow. CONCLUSIONS-: The spatial extent of acute and healed myocardial infarction can be determined and quantified accurately with contrast-enhanced MDCT. This feature, combined with existing high-resolution MDCT coronary angiography, may have important implications for the comprehensive assessment of cardiovascular disease.

Original languageEnglish (US)
Pages (from-to)394-404
Number of pages11
JournalCirculation
Volume113
Issue number3
DOIs
StatePublished - Jan 2006

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Multidetector Computed Tomography
Muscle Cells
Cicatrix
Myocardial Infarction
Reperfusion
Microspheres
Swine
Staining and Labeling
Balloon Occlusion
Coronary Angiography
Canidae
Coronary Vessels
Myocardium
Necrosis
Cardiovascular Diseases
Dogs
Injections
Wounds and Injuries

Keywords

  • Contrast media
  • Heart diseases
  • Imaging
  • Myocardial infarction
  • Tomography

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Contrast-enhanced multidetector computed tomography viability imaging after myocardial infarction : Characterization of myocyte death, microvascular obstruction, and chronic scar. / Lardo, Albert C.; Cordeiro, Marco A S; Silva, Caterina; Amado, Luciano C.; George, Richard T.; Saliaris, Anastasios P.; Schuleri, Karl H.; Fernandes, Veronica R.; Zviman, Menekhem; Nazarian, Saman; Halperin, Henry R; Wu, Katherine Chih-Ching; Hare, Joshua M.; Lima, Joao.

In: Circulation, Vol. 113, No. 3, 01.2006, p. 394-404.

Research output: Contribution to journalArticle

Lardo, Albert C. ; Cordeiro, Marco A S ; Silva, Caterina ; Amado, Luciano C. ; George, Richard T. ; Saliaris, Anastasios P. ; Schuleri, Karl H. ; Fernandes, Veronica R. ; Zviman, Menekhem ; Nazarian, Saman ; Halperin, Henry R ; Wu, Katherine Chih-Ching ; Hare, Joshua M. ; Lima, Joao. / Contrast-enhanced multidetector computed tomography viability imaging after myocardial infarction : Characterization of myocyte death, microvascular obstruction, and chronic scar. In: Circulation. 2006 ; Vol. 113, No. 3. pp. 394-404.
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abstract = "BACKGROUND-: The ability to distinguish dysfunctional but viable myocardium from nonviable tissue has important prognostic implications after myocardial infarction. The purpose of this study was to validate the accuracy of contrast-enhanced multidetector computed tomography (MDCT) for quantifying myocardial necrosis, microvascular obstruction, and chronic scar after occlusion/reperfusion myocardial infarction. METHODS AND RESULTS-: Ten dogs and 7 pigs underwent balloon occlusion of the left anterior descending coronary artery (LAD) followed by reperfusion. Contrast-enhanced (Visipaque, 150 mL, 325 mg/mL) MDCT (0.5 mm x 32 slice) was performed before occlusion and 90 minutes (canine) or 8 weeks (porcine) after reperfusion. MDCT images were analyzed to define infarct size/extent and microvascular obstruction and compared with postmortem myocardial staining (triphenyltetrazolium chloride) and microsphere blood flow measurements. Acute and chronic infarcts by MDCT were characterized by hyperenhancement, whereas regions of microvascular obstruction were characterized by hypoenhancement. MDCT infarct volume compared well with triphenyltetrazolium chloride staining (acute infarcts 21.1±7.2{\%} versus 20.4±7.4{\%}, mean difference 0.7{\%}; chronic infarcts 4.15±1.93{\%} versus 4.92±2.06{\%}, mean difference 0.76{\%}) and accurately reflected morphology and the transmural extent of injury in all animals. Peak hyperenhancement of infarcted regions occurred ≈5 minutes after contrast injection. MDCT-derived regions of microvascular obstruction were also identified accurately in acute studies and correlated with reduced flow regions as measured by microsphere blood flow. CONCLUSIONS-: The spatial extent of acute and healed myocardial infarction can be determined and quantified accurately with contrast-enhanced MDCT. This feature, combined with existing high-resolution MDCT coronary angiography, may have important implications for the comprehensive assessment of cardiovascular disease.",
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T2 - Characterization of myocyte death, microvascular obstruction, and chronic scar

AU - Lardo, Albert C.

AU - Cordeiro, Marco A S

AU - Silva, Caterina

AU - Amado, Luciano C.

AU - George, Richard T.

AU - Saliaris, Anastasios P.

AU - Schuleri, Karl H.

AU - Fernandes, Veronica R.

AU - Zviman, Menekhem

AU - Nazarian, Saman

AU - Halperin, Henry R

AU - Wu, Katherine Chih-Ching

AU - Hare, Joshua M.

AU - Lima, Joao

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N2 - BACKGROUND-: The ability to distinguish dysfunctional but viable myocardium from nonviable tissue has important prognostic implications after myocardial infarction. The purpose of this study was to validate the accuracy of contrast-enhanced multidetector computed tomography (MDCT) for quantifying myocardial necrosis, microvascular obstruction, and chronic scar after occlusion/reperfusion myocardial infarction. METHODS AND RESULTS-: Ten dogs and 7 pigs underwent balloon occlusion of the left anterior descending coronary artery (LAD) followed by reperfusion. Contrast-enhanced (Visipaque, 150 mL, 325 mg/mL) MDCT (0.5 mm x 32 slice) was performed before occlusion and 90 minutes (canine) or 8 weeks (porcine) after reperfusion. MDCT images were analyzed to define infarct size/extent and microvascular obstruction and compared with postmortem myocardial staining (triphenyltetrazolium chloride) and microsphere blood flow measurements. Acute and chronic infarcts by MDCT were characterized by hyperenhancement, whereas regions of microvascular obstruction were characterized by hypoenhancement. MDCT infarct volume compared well with triphenyltetrazolium chloride staining (acute infarcts 21.1±7.2% versus 20.4±7.4%, mean difference 0.7%; chronic infarcts 4.15±1.93% versus 4.92±2.06%, mean difference 0.76%) and accurately reflected morphology and the transmural extent of injury in all animals. Peak hyperenhancement of infarcted regions occurred ≈5 minutes after contrast injection. MDCT-derived regions of microvascular obstruction were also identified accurately in acute studies and correlated with reduced flow regions as measured by microsphere blood flow. CONCLUSIONS-: The spatial extent of acute and healed myocardial infarction can be determined and quantified accurately with contrast-enhanced MDCT. This feature, combined with existing high-resolution MDCT coronary angiography, may have important implications for the comprehensive assessment of cardiovascular disease.

AB - BACKGROUND-: The ability to distinguish dysfunctional but viable myocardium from nonviable tissue has important prognostic implications after myocardial infarction. The purpose of this study was to validate the accuracy of contrast-enhanced multidetector computed tomography (MDCT) for quantifying myocardial necrosis, microvascular obstruction, and chronic scar after occlusion/reperfusion myocardial infarction. METHODS AND RESULTS-: Ten dogs and 7 pigs underwent balloon occlusion of the left anterior descending coronary artery (LAD) followed by reperfusion. Contrast-enhanced (Visipaque, 150 mL, 325 mg/mL) MDCT (0.5 mm x 32 slice) was performed before occlusion and 90 minutes (canine) or 8 weeks (porcine) after reperfusion. MDCT images were analyzed to define infarct size/extent and microvascular obstruction and compared with postmortem myocardial staining (triphenyltetrazolium chloride) and microsphere blood flow measurements. Acute and chronic infarcts by MDCT were characterized by hyperenhancement, whereas regions of microvascular obstruction were characterized by hypoenhancement. MDCT infarct volume compared well with triphenyltetrazolium chloride staining (acute infarcts 21.1±7.2% versus 20.4±7.4%, mean difference 0.7%; chronic infarcts 4.15±1.93% versus 4.92±2.06%, mean difference 0.76%) and accurately reflected morphology and the transmural extent of injury in all animals. Peak hyperenhancement of infarcted regions occurred ≈5 minutes after contrast injection. MDCT-derived regions of microvascular obstruction were also identified accurately in acute studies and correlated with reduced flow regions as measured by microsphere blood flow. CONCLUSIONS-: The spatial extent of acute and healed myocardial infarction can be determined and quantified accurately with contrast-enhanced MDCT. This feature, combined with existing high-resolution MDCT coronary angiography, may have important implications for the comprehensive assessment of cardiovascular disease.

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KW - Heart diseases

KW - Imaging

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KW - Tomography

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