TY - JOUR
T1 - Technology insight
T2 - Assessment of myocardial viability by delayed-enhancement magnetic resonance imaging
AU - Judd, Robert M.
AU - Wagner, Anja
AU - Rehwald, Wolfgang G.
AU - Albert, Timothy
AU - Kim, Raymond J.
PY - 2005/3/1
Y1 - 2005/3/1
N2 - Myocardial viability is of established importance to the management of cardiac patients being considered for revascularization. Existing noninvasive imaging tests to examine myocardial viability, such as stress echocardiography and nuclear scintigraphy, are of recognized utility but are subject to intrinsic limitations. Over the past few years delayed-enhancement MRI (DE-MRI) has emerged as an alternative to traditional tests and for the first time allows direct visualization of the transmural extent of myocardial viability. In this paper we review the scientific data that underlie the use of DE-MRI in patients with ischemic heart disease. Progress in this area is largely the result of the development of a new MRI pulse sequence in the late 1990s, which improved the detection of necrotic and scarred myocardial tissue. Following this technical development, a series of detailed histologic comparisons in large animal models revealed that both acute and healed myocardial infarcts appeared as brighter (hyperenhanced) areas than viable regions, and that the effect is independent of contractile function. The resulting 'bright is dead' hypothesis has thus far proven of significant use in patients with ischemic heart disease. Data are now emerging which suggest that the DE-MRI technique also has important implications for patients with nonischemic forms of cardiomyopathy.
AB - Myocardial viability is of established importance to the management of cardiac patients being considered for revascularization. Existing noninvasive imaging tests to examine myocardial viability, such as stress echocardiography and nuclear scintigraphy, are of recognized utility but are subject to intrinsic limitations. Over the past few years delayed-enhancement MRI (DE-MRI) has emerged as an alternative to traditional tests and for the first time allows direct visualization of the transmural extent of myocardial viability. In this paper we review the scientific data that underlie the use of DE-MRI in patients with ischemic heart disease. Progress in this area is largely the result of the development of a new MRI pulse sequence in the late 1990s, which improved the detection of necrotic and scarred myocardial tissue. Following this technical development, a series of detailed histologic comparisons in large animal models revealed that both acute and healed myocardial infarcts appeared as brighter (hyperenhanced) areas than viable regions, and that the effect is independent of contractile function. The resulting 'bright is dead' hypothesis has thus far proven of significant use in patients with ischemic heart disease. Data are now emerging which suggest that the DE-MRI technique also has important implications for patients with nonischemic forms of cardiomyopathy.
KW - Contrast agents
KW - Magnetic resonance imaging
KW - Myocardial infarction
KW - Myocardial ischemia
KW - Myocardial viability
UR - http://www.scopus.com/inward/record.url?scp=20444500219&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=20444500219&partnerID=8YFLogxK
U2 - 10.1038/ncpcardio0134
DO - 10.1038/ncpcardio0134
M3 - Review article
C2 - 16265459
AN - SCOPUS:20444500219
SN - 1743-4297
VL - 2
SP - 150
EP - 158
JO - Nature Clinical Practice Cardiovascular Medicine
JF - Nature Clinical Practice Cardiovascular Medicine
IS - 3
ER -