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      T2-weighted cardiovascular magnetic resonance in acute cardiac disease

      review-article
      Author(s): 1 , 2 , 2 ,
      Publication date (Electronic):
      Journal: Journal of Cardiovascular Magnetic Resonance
      Publisher: BioMed Central

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          Abstract

          Cardiovascular magnetic resonance (CMR) using T2-weighted sequences can visualize myocardial edema. When compared to previous protocols, newer pulse sequences with substantially improved image quality have increased its clinical utility. The assessment of myocardial edema provides useful incremental diagnostic and prognostic information in a variety of clinical settings associated with acute myocardial injury. In patients with acute chest pain, T2-weighted CMR is able to identify acute or recent myocardial ischemic injury and has been employed to distinguish acute coronary syndrome (ACS) from non-ACS as well as acute from chronic myocardial infarction.

          T2-weighted CMR can also be used to determine the area at risk in reperfused and non-reperfused infarction. When combined with contrast-enhanced imaging, the salvaged area and thus the success of early coronary revascularization can be quantified. Strong evidence for the prognostic value of myocardial salvage has enabled its use as a primary endpoint in clinical trials. The present article reviews the current evidence and clinical applications for T2-weighted CMR in acute cardiac disease and gives an outlook on future developments.

          "The principle of all things is water"

          Thales of Miletus (624 BC - 546 BC)

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          Most cited references64

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          The stunned myocardium: prolonged, postischemic ventricular dysfunction.

          R Kloner, E Braunwald (1982)
          Myocardial ischemia has, for many decades, been viewed as an all-or-none process that causes myocardial necrosis when prolonged and severe, but whose effects are transient when it is brief or mild. In view of the evidence that the ischemic process may "hit, run and stun," perhaps our thinking about the consequences of myocardial ischemia should be expanded. According to this formulation, an ischemic insult not of sufficient severity of duration to produce myocardial necrosis may acutely affect myocardial repolarization and cause angina (hit); but these changes wane rapidly (run), when the balance between myocardial oxygen supply and demand has been reestablished. However, the ischemia may interfere with normal myocardial function, biochemical processes and ultrastructure for prolonged periods (stun). The severity and duration of these postischemic changes depend on the length and intensity of the ischemia, as well as on the condition of the myocardium at the onset of the ischemic episode. Furthermore, it is likely that when the myocardium is repeatedly stunned, it may exhibit chronic postischemic left ventricular dysfunction, an ill-defined condition. If prolonged, chronic postischemic left ventricular dysfunction can progress to myocardial scarring and ischemic cardiomyopathy, it may be important to determine how often it can be ameliorated by permanent improvement of myocardial perfusion by surgical treatment.
          Article 0 comments Cited 118 times – based on 0 reviews     Review now
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            Clinical indications for cardiovascular magnetic resonance (CMR): Consensus Panel report.

            U. Sechtem, E C Yücel, Frank E Rademakers … (2004)
            Article 0 comments Cited 115 times – based on 0 reviews     Review now
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              Prognostic significance and determinants of myocardial salvage assessed by cardiovascular magnetic resonance in acute reperfused myocardial infarction.

              Ingo Eitel, Steffen Desch, Georg Fuernau … (2010)
              The aim of the study was to determine the prognostic significance and determinants of myocardial salvage assessed by cardiovascular magnetic resonance (CMR) in reperfused ST-segment elevation myocardial infarction. In acute myocardial infarction, CMR can retrospectively detect the myocardium at risk and the irreversible injury. This allows for quantifying the extent of salvaged myocardium after reperfusion as a potential strong end point for clinical trials and outcome. We analyzed 208 consecutive ST-segment elevation myocardial infarction patients undergoing primary angioplasty or= median group (2.9% vs. 22.1%, p < 0.001). The stepwise Cox proportional hazards model revealed that the MSI was the strongest predictor of major adverse cardiovascular events at 6-month follow-up (p < 0.001). All prognostic clinical (symptom onset to reperfusion), angiographic (Thrombolysis In Myocardial Infarction flow grade before angioplasty), and electrocardiographic (ST-segment resolution) parameters showed significant correlations with the MSI (p < 0.001 for all). This study for the first time demonstrates that the MSI assessed by CMR predicts the outcome in acute reperfused ST-segment elevation myocardial infarction. Therefore, MSI assessment has important implications for patient prognosis as well as for the design of future trials intended to test new reperfusion therapy efficacy. (Myocardial Salvage Assessed by Cardiovascular Magnetic Resonance-Impact on Outcome; NCT00952224).
              Article 0 comments Cited 112 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Cardiovasc Magn Reson
                Title: Journal of Cardiovascular Magnetic Resonance
                Publisher: BioMed Central
                ISSN (Print): 1097-6647
                ISSN (Electronic): 1532-429X
                Publication date Collection: 2011
                Publication date (Electronic): 18 February 2011
                Volume: 13
                Issue: 1
                Page: 13
                Affiliations
                [1 ]University of Leipzig - Heart Center, Department of Internal Medicine - Cardiology, Leipzig, Germany
                [2 ]Stephenson Cardiovascular Magnetic Resonance Centre at the Libin Cardiovascular Institute of Alberta, Departments of Cardiac Sciences and Radiology, University of Calgary, Calgary, Canada
                Article
                Publisher ID: 1532-429X-13-13
                DOI: 10.1186/1532-429X-13-13
                PMC ID: 3060149
                PubMed ID: 21332972
                SO-VID: f52f5281-bbb7-42d2-ae88-4a77038b7b52
                Copyright © Copyright ©2011 Eitel and Friedrich; licensee BioMed Central Ltd.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 4 January 2011
                Date accepted : 18 February 2011
                Categories
                Subject: Review

                ScienceOpen disciplines: Cardiovascular Medicine
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine

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