Acute myocardial infarction (AMI) is a leading cause of mortality and morbidity in
the world, despite the rate having significantly declined over the past decade. The
aim of this review is to consider the emerging diagnostic and clinical utility of
cardiac MRI in patients with recent AMI.
Cardiac MRI has high reproducibility and accuracy, allowing detailed functional assessment
and characterisation of myocardial tissue. In addition to traditional measures including
infarct size (IS), transmural extent of necrosis and microvascular obstruction (MVO),
other infarct characteristics can now be identified using innovative MRI techniques.
These novel pathologies include myocardial oedema and myocardial haemorrhage which
also have functional and prognostic implications for patients. In addition to its
diagnostic utility in ordinary clinical practice, cardiac MRI has been increasingly
used to provide information on surrogate outcome measures, such as left ventricular
ejection fraction (LVEF) and volumes, in clinical trials. MRI is becoming more available
in secondary care, however, the potential clinical utility and cost effectiveness
of MRI in post-MI patients remains uncertain. Cardiac MRI is most likely to be useful
in high risk patients with risk factors for heart failure (HF). This includes individuals
with early signs of pump failure and risk factors for adverse remodelling, such as
MVO. This review focuses on the role of cardiac MRI in the assessment of patients
with AMI.
Keywords
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References
- Decline in rates of death and heart failure in acute coronary syndromes, 1999–2006.JAMA. 2007; 297: 1892-1900
- Underestimated and under-recognized: the late consequences of acute coronary syndrome (GRACE UK–Belgian Study).Eur Heart J. 2010; 32: 2755-2764
- The wavefront phenomenon of ischemic cell death. Myocardial infarct size vs. duration of coronary occlusion in dogs.Circulation. 1977; 56: 788-794
- Clinical implications of the “no reflow” phenomenon. A predictor of complications and left ventricular remodelling in reperfused anterior wall myocardial infarction.Circulation. 1996; 93: 223-228
- Myocardial reperfusion injury.New Engl J Med. 2007; 357: 1121-1135
- Ventricular remodelling after myocardial infarction: experimental observations and clinical implications.Circulation. 1990; 81: 1161-1172
- 3 Tesla MR imaging provides improved contrast in first-pass myocardial perfusion imaging over a range of gadolinium doses.J Cardiovasc Magn Reson. 2005; 7: 559-564
- Magnetic resonance imaging in the detection of myocardial viability: the role of delayed contrast hyperenhancement.Hellenic J Cardiol. 2005; 46: 108-116
- Comprehensive cardiac magnetic resonance imaging at 3.0 Tesla: feasibility and implications for clinical applications.Invest Radiol. 2006; 41: 154-167
- Coronary MR angiography at 3T during diastole and systole.J Magn Reson Imaging. 2007; 26: 921-926
- Diagnostic value of contrast-enhanced magnetic resonance imaging and single- photon emission computed tomography for detection of myocardial necrosis early after acute myocardial infarction.J Am Coll Cardiol. 2007; 49: 208-216
- Acute myocardial infarction: myocardial viability assessment in patients early thereafter comparison of contrast-enhanced MR imaging with resting (201) Tl SPECT: single photon emission computed tomography.Radiology. 2003; 226: 138-144
- Contrast-enhanced MRI and routine single photon emission computed tomography (SPECT) perfusion imaging for detection of subendocardial myocardial infarcts: an imaging study.Lancet. 2003; 361: 374-379
- Cardiovascular MRI for detection of myocardial viability and ischaemia.Heart. 2007; 93: 122-129
- Myocardial viability by contrast-enhanced cardiovascular magnetic resonance in patients with coronary artery disease: comparison with gated single-photon emission tomography and FDG position emission tomography.Int J Cardiovasc Imaging. 2007; 23: 757-765
- Assessment of regional left ventricular function by magnetic resonance.Br Heart J. 1986; 56: 334-340
- Interstudy reproducibility of right ventricular volumes, function and mass with cardiovascular magnetic resonance.Am Heart J. 2004; 147: 218-223
- Left ventricular volumes measured by MR imaging.Radiology. 1985; 156: 717-719
- Bright blood T2 weighted MRI has higher diagnostic accuracy than dark blood STIR MRI for detection of acute myocardial infarction and for assessment of the ischemic area-at-risk and myocardial salvage.Circ Cardiovasc Imaging. 2011; 4: 210-219
- Motion-corrected free breathing delayed enhancement imaging of myocardial infarction.Magn Reson Med. 2005; 53: 194-200
- Retrospective determination of the area at risk for reperfused acute myocardial infarction with T2-weighted cardiac magnetic resonance imaging: histopathological and displacement encoding with stimulated echoes (DENSE) functional validations.Circulation. 2006; 113: 1865-1870
- Quantification of myocardial area at risk with T2-weighted CMR: comparison with contrast-enhanced CMR and coronary angiography.J Am Coll Cardiol Img. 2009; 2: 825-831
- Myocardium at risk after acute infarction in humans on cardiac magnetic resonance: quantitative assessment during follow-up and validation with single-photon emission computed tomography.J AmColl Cardiol Img. 2009; 2: 569-576
- Cardiac magnetic resonance with edema imaging identifies myocardium at risk and predicts worse outcome in patients with non-ST-segment elevation acute coronary syndrome.J Am Coll Cardiol. 2010; 55: 2480-2488
- Prognostic significance and determinants of myocardial salvage assessed by cardiovascular magnetic resonance in acute reperfused myocardial infarction.J Am Coll Cardiol. 2010; 55: 2470-2479
- Long-term prognostic value of myocardial salvage assessed by cardiovascular magnetic resonance in acute reperfused myocardial infarction.Heart. 2011; 97: 2038-2045
- Edema as a very early marker for acute myocardial ischemia: a cardiovascular magnetic resonance study.J Am Coll Cardiol. 2009; 53: 1194-1201
- Delayed enhancement and T2-weighted cardiovascular magnetic resonance imaging differentiate acute from chronic myocardial infarction.Circulation. 2004; 109: 2411-2416
- Myocardial edema as detected by precontrast T1 and T2 CMR delineates area at risk associated with acute myocardial infarction.J Am Coll Cardiol Img. 2012; 5: 596-603
- Direct T2 quantification of myocardial edema in acute ischemic injury.JACC Cardiovasc Imaging. 2011; 4: 269-278
- Cardiac magnetic resonance with T2-weighted imaging improves detection of patients with acute coronary syndrome in the emergency department.Circulation. 2008; 118: 837-844
- The metamorphosis of myocardial infarction following coronary recanalization.Cardiovasc Pathol. 2010; 19: 22-28
- Impact of myocardial haemorrhage on left ventricular function and remodelling in patients with reperfused acute myocardial infarction.Eur Heart J. 2009; 30: 1440-1449
- Reperfusion haemorrhage as determined by cardiovascular MRI is a predictor of adverse left ventricular remodelling and markers of late arrhythmic risk.Heart. 2011; 97: 453-459
- Reperfusion haemorrhage following acute myocardial infarction: assessment with T2 mapping and effect on measuring the area at risk.Radiology. 2009; 250: 916-922
- Myocardial T2 mapping free of distortion using susceptibility-weighted fast spin-echo imaging: a feasibility study at 1.5 T and 3.0 T.Magn Reson Med. 2009; 62: 822-828
- An improved MR imaging technique for the visualization of myocardial infarction.Radiology. 2001; 218: 215-223
- Relationship of MRI delayed contrast enhancement to irreversible injury, infarct age, and contractile function.Circulation. 1999; 100: 1992-2002
- Physiological basis of myocardial contrast enhancement in fast magnetic resonance images of a 2-day-old reperfused canine infarcts.Circulation. 1995; 92: 1902-1910
- Magnetic resonance characterization of the peri-infarction zone of reperfused myocardial infarction with necrosis-specific and extracellular nonspecific contrast media.Circulation. 2001; 103: 871-876
- Sequelae of acute myocardial infarction regarding cardiac structure and function and their prognostic significance as assessed by magnetic resonance imaging.Eur Heart J. 2005; 26: 549-557
- Gadolinium delayed enhancement cardiovascular magnetic resonance correlates with clinical measures of myocardial infarction.J Am Coll Cardiol. 2004; 43: 2253-2259
- Assessment of myocardial viability by contrast enhancement.in: Higgins C.B. Roos A.D. Cardiovascular MRI and MRA. Lippincott-Williams &Wilkins, Philadelphia, PA2003: 209-236
- Measuring myocardial scar by CMR.JACC Cardiovasc Imaging. 2011; 4: 157-160
- Visualisation of presence, location, and transmural extent of healed Q-wave and non–Q-wave myocardial infarction.Lancet. 2001; 357: 21-28
- Assessment of myocardial viability with contrast-enhanced magnetic resonance imaging: comparison with positron emission tomography.Circulation. 2002; 105: 162-167
- Quantitative measurement of infarct size by contrast-enhanced magnetic resonance imaging early after acute myocardial infarction: comparison with single-photon emission tomography usingTc99m-sestamibi.J Am Coll Cardiol. 2005; 45: 544-552
- The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction.New Engl J Med. 2000; 343: 1445-1453
- Contrast-enhanced magnetic resonance imaging of myocardium at risk: distinction between reversible and irreversible injury throughout infarct healing.J Am Coll Cardiol. 2000; 36: 1985-1991
- Standardizing the definition of hyperenhancement in the quantitative assessment of infarct size and myocardial viability using delayed contrast-enhanced CMR.J Cardiovasc Magn Reson. 2005; 7: 481-485
- Transmural extent of acute myocardial infarction predicts long-term improvement in contractile function.Circulation. 2001; 104: 1101-1107
- Relationship of contractile function to transmural extent of infarction in patients with chronic coronary artery disease.J Am Coll Cardiol. 2003; 42: 505-512
- Accuracy of contrast-enhanced magnetic resonance imaging in predicting improvement of regional myocardial function in patients after acute myocardial infarction.Circulation. 2002; 106: 1083-1089
- Clinical, imaging, and pathological characteristics of left ventricular thrombus: a comparison of contrast-enhanced magnetic resonance imaging, transthoracic echocardiography, and transesophageal echocardiography with surgical or pathological validation.Am Heart J. 2006; 152: 75-84
- Contrast-enhanced anatomic imaging as compared to contrast-enhanced tissue characterization for detection of left ventricular thrombus.JACC Cardiovasc Imaging. 2009; 2: 969-979
- Quantification and time course of microvascular obstruction by contrast-enhanced echocardiography and magnetic resonance imaging following acute myocardial infarction and reperfusion.J Am Coll Cardiol. 1998; 32: 1756-1764
- Influence of transmurality, infarct size, and severe microvascular obstruction on left ventricular remodelling and function after primary coronary angioplasty.Am J Cardiol. 2006; 98: 1033-1040
- Prognostic significance of microvascular obstruction by magnetic resonance imaging in patients with acute myocardial infarction.Circulation. 1998; 97: 765-772
- Haemorrhagic myocardial infarction after coronary reperfusion detected in vivo by magnetic resonance imaging in humans: prevalence and clinical implications.J Cardiovasc Magn Resonan. 1999; 1: 247-256
- Meta-analysis of the diagnostic performance of stress perfusion cardiovascular magnetic resonance for detection of coronary artery disease.J Cardiovasc Magn Reson. 2010; 12: 29
- Acute myocardial infarction: evaluation with first-pass enhancement and delayed enhancement MR imaging compared with 201Tl SPECT imaging.Radiology. 2004; 232: 49-57
- Echoplanar MR imaging of normal and ischemic myocardium with gadodiamide injection.Radiology. 1993; 186: 535-542
- Detecting acute coronary syndrome in the emergency department with cardiac magnetic resonance imaging.Circulation. 2003; 107: 531-537
- First pass cardiac perfusion: evaluation with ultrafast MR imaging.Radiology. 1990; 174: 757-762
- Comparison of T1-enhancing and magnetic susceptibility magnetic resonance contrast agents for demarcation of the jeopardy area in experimental myocardial infarction.Invest Radiol. 1993; 28: 1015-1023
- Direct cardiac NMR imaging of heart wall and blood flow velocity.J Comput Assist Tomogr. 1984; 8: 588-593
- Evaluation of the precision of magnetic resonance phase velocity mapping for blood flow measurements.J Cardiovasc Magn Reson Imaging. 2001; 3: 27-34
- Aortic valve pressure gradients in patients with aortic valve stenosis: quantification with velocity-encoded cine MR imaging.AJR. 1993; 160: 971-977
- Severity of aortic regurgitation: an interstudy reproducibility of measurements with velocity encoded cine MRI.Radiology. 1992; 185: 235-240
- Towards comprehensive assessment of mitral regurgitation using cardiovascular magnetic resonance.J Cardiovasc Magn Reson. 2008; 22: 61
- Peri-infarct dysfunction in post-myocardial infarction: assessment of 3-T tagged and late enhancement MRI.Eur Radiol. 2010; 20: 1139-1148
- Electromechanical characteristics of myocardial infarction border zones and ventricular arrhythmic risk: novel insights from grid-tagged cardiac magnetic resonance imaging.Eur Radiol. 2012; 22: 1651-1658
- Regional differences in shape and load in normal and diseased hearts studied by three dimensional tagged magnetic resonance imaging.Int J Card Imaging. 1999; 15: 309-321
- Delineation of normal human left ventricular twist throughout systole by tagged cine magnetic resonance imaging.J Cardiovasc Magn Reson. 2000; 2: 97-108
- Measuring treatment effects in clinical trials using cardiac MRI.Curr Cardiovasc Imaging Rep. 2011; 4: 98-107
- Risk stratification survival after myocardial infarction.N Engl J Med. 1983; 309: 331-336
- Long-term prognostic value of myocardial salvage assessed by cardiovascular magnetic resonance in acute reperfused myocardial infarction.Heart. 2011; 97: 2038-2045
- Stress cardiac magnetic resonance imaging with observation unit care reduces cost for patients with emergent chest pain: a randomized trial.Ann Emerg Med. 2010; 56: 209e2-219e2
- Characterization of patients with acute chest pain using cardiac magnetic resonance imaging.Clin Res Cardiol. 2008; 97: 760-777
- Clinical characteristics and role of early cardiac magnetic resonance imaging in patients with suspected ST-elevation myocardial infarction and normal coronary arteries.Int J Cardiovasc Imaging (formerly Cardiac Imaging). 2010; : 1-11
- Transmural distribution of myocardial edema by NMR relaxometry following myocardial ischemia and reperfusion.Am Heart J. 1991; 122 (60): 655-664
- Cardiovascular magnetic resonance in myocarditis: a JACC White Paper.J Am Coll Cardiol. 2009; 53: 1475-1487
Article info
Publication history
Accepted:
November 12,
2012
Received in revised form:
November 10,
2012
Received:
July 14,
2012
Identification
Copyright
© 2012 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier Inc. All rights reserved.
