Please use this identifier to cite or link to this item:http://hdl.handle.net/20.500.12105/5518
Myocardial Edema After Ischemia/Reperfusion Is Not Stable and Follows a Bimodal Pattern Imaging and Histological Tissue Characterization
Fernandez-Jimenez, Rodrigo CNIC | Sanchez-Gonzalez, Javier CNIC | Aguero, Jaume CNIC | Garcia-Prieto, Jaime CNIC | Lopez-Martin, Gonzalo J. CNIC | Garcia-Ruiz, Jose M CNIC | Molina-Iracheta, Antonio CNIC | Rossello, Xavier CNIC | Fernandez-Friera, Leticia CNIC | Pizarro, Gonzalo CNIC | Garcia-Alvarez, Ana CNIC | Dall'Armellina, Erica | Macaya, Carlos | Choudhury, Robin P | Fuster, Valentin CNIC | Ibanez, Borja CNIC
J Am Coll Cardiol. 2015 Feb 3;65(4):315-323
BACKGROUND It is widely accepted that edema occurs early in the ischemic zone and persists in stable form for at least 1 week after myocardial ischemia/reperfusion. However, there are no longitudinal studies covering from very early (minutes) to late (1 week) reperfusion stages confirming this phenomenon. OBJECTIVES This study sought to perform a comprehensive longitudinal imaging and histological characterization of the edematous reaction after experimental myocardial ischemia/reperfusion. METHODS The study population consisted of 25 instrumented Large-White pigs (30 kg to 40 kg). Closed-chest 40-min ischemia/reperfusion was performed in 20 pigs, which were sacrificed at 120 min (n = 5), 24 h (n = 5), 4 days (n = 5), and 7 days (n = 5) after reperfusion and processed for histological quantification of myocardial water content. Cardiac magnetic resonance (CMR) scans with T2-weighted short-tau inversion recovery and T2-mapping sequences were performed at every follow-up stage until sacrifice. Five additional pigs sacrificed after baseline CMR served as controls. RESULTS In all pigs, reperfusion was associated with a significant increase in T2 relaxation times in the ischemic region. On 24-h CMR, ischemic myocardium T2 times returned to normal values (similar to those seen pre-infarction). Thereafter, ischemic myocardium-T2 times in CMR performed on days 4 and 7 after reperfusion progressively and systematically increased. On day 7 CMR, T2 relaxation times were as high as those observed at reperfusion. Myocardial water content analysis in the ischemic region showed a parallel bimodal pattern: 2 high water content peaks at reperfusion and at day 7, and a significant decrease at 24 h. CONCLUSIONS Contrary to the accepted view, myocardial edema during the first week after ischemia/reperfusion follows a bimodal pattern. The initial wave appears abruptly upon reperfusion and dissipates at 24 h. Conversely, the deferred wave of edema appears progressively days after ischemia/reperfusion and is maximal around day 7 after reperfusion. (C) 2015 by the American College of Cardiology Foundation.
CMR | MRI | Myocardial infarction | pig | T2 | Water content | CARDIAC MAGNETIC-RESONANCE | PERCUTANEOUS CORONARY INTERVENTION | INFARCT SIZE | REPERFUSION INJURY | TRANSIENT PERIOD | RISK | AREA | ISCHEMIA | CONTRAST
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