The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction

Raymond J. Kim, Edwin Wu, Allen Rafael, Enn Ling Chen, Michele A. Parker, Orlando Simonetti, Francis J. Klocke, Robert O. Bonow, Robert M. Judd

Research output: Contribution to journalArticle

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 non-viable 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. (C) 2000, Massachusetts Medical Society.

Original languageEnglish (US)
Pages (from-to)1445-1453
Number of pages9
JournalNew England Journal of Medicine
Volume343
Issue number20
DOIs
StatePublished - Nov 16 2000

ASJC Scopus subject areas

  • Medicine(all)

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  • Cite this

    Kim, R. J., Wu, E., Rafael, A., Chen, E. L., Parker, M. A., Simonetti, O., Klocke, F. J., Bonow, R. O., & Judd, R. M. (2000). The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. New England Journal of Medicine, 343(20), 1445-1453. https://doi.org/10.1056/NEJM200011163432003