2026-06-14T03:30:35Zhttps://repisalud.isciii.es/rest/oai/requestoai:repisalud.isciii.es:20.500.12105/64952024-09-27T09:33:21Zcom_20.500.12105_19604com_20.500.12105_2051col_20.500.12105_19605
Repisalud
author
Fernandez-Jimenez, Rodrigo
author
Barreiro-Perez, Manuel
author
Martin-Garcia, Ana
author
Sanchez-Gonzalez, Javier
author
Aguero, Jaume
author
Galan-Arriola, Carlos
author
Garcia-Prieto, Jaime
author
Diaz-Pelaez, Elena
author
Vara, Pedro
author
Martinez, Irene
author
Zamarro, Ivan
author
Garde, Beatriz
author
Sanz, Javier
author
Fuster, Valentin
author
Sánchez, Pedro L
author
Ibáñez, Borja
funder
Sociedad Española de Cardiología
funder
Instituto de Salud Carlos III
funder
Unión Europea. Fondo Europeo de Desarrollo Regional (FEDER/ERDF)
funder
Ministerio de Economía, Industria y Competitividad (España)
funder
Fundación Jesús Serra
funder
Fundación Interhospitalaria de Investigación Cardiovascular
funder
Centro Nacional de Investigaciones Cardiovasculares Carlos III (España)
funder
Fundación ProCNIC
2018-10-19T08:00:43Z
2018-10-19T08:00:43Z
2017
Circulation. 2017; 136(14):1288-1300
10.1161/CIRCULATIONAHA.116.025582
1524-4539
0009-7322
Circulation
28687712
http://hdl.handle.net/20.500.12105/6495
BACKGROUND: Clinical protocols aimed to characterize the post-myocardial
infarction (MI) heart by cardiac magnetic resonance (CMR) need to be
standardized to take account of dynamic biological phenomena evolving
early after the index ischemic event. Here, we evaluated the time course
of edema reaction in patients with ST-segment-elevation MI by CMR and
assessed its implications for myocardium-at-risk (MaR) quantification
both in patients and in a large-animal model.
METHODS: A total of 16 patients with anterior ST-segment-elevation MI
successfully treated by primary angioplasty and 16 matched controls were
prospectively recruited. In total, 94 clinical CMR examinations were
performed: patients with ST-segment-elevation MI were serially scanned
(within the first 3 hours after reperfusion and at 1, 4, 7, and 40
days), and controls were scanned only once. T2 relaxation time in the
myocardium (T2 mapping) and the extent of edema on T2-weighted short-tau
triple inversion-recovery (ie, CMR-MaR) were evaluated at all time
points. In the experimental study, 20 pigs underwent 40-minute
ischemia/reperfusion followed by serial CMR examinations at 120 minutes
and 1, 4, and 7 days after reperfusion. Reference MaR was assessed by
contrast-multidetector computed tomography during the index coronary
occlusion. Generalized linear mixed models were used to take account of
repeated measurements.
RESULTS: In humans, T2 relaxation time in the ischemic myocardium
declines significantly from early after reperfusion to 24 hours, and
then increases up to day 4, reaching a plateau from which it decreases
from day 7. Consequently, edema extent measured by T2-weighted short-tau
triple inversion-recovery (CMR-MaR) varied with the timing of the CMR
examination. These findings were confirmed in the experimental model by
showing that only CMR-MaR values for day 4 and day 7 postreperfusion,
coinciding with the deferred edema wave, were similar to values measured
by reference contrast-multidetector computed tomography.
CONCLUSIONS: Post-MI edema in patients follows a bimodal pattern that
affects CMR estimates of MaR. Dynamic changes in
post-ST-segment-elevation MI edema highlight the need for
standardization of CMR timing to retrospectively delineate MaR and
quantify myocardial salvage. According to the present clinical and
experimental data, a time window between days 4 and 7 post-MI seems a
good compromise solution for standardization. Further studies are needed
to study the effect of other factors on these variables.
eng
Edema
Magnetic resonance imaging
Myocardial infarction
Translational medical research
ST-SEGMENT ELEVATION
CARDIAC MAGNETIC-RESONANCE
2013 ACCF/AHA GUIDELINE
ASSOCIATION TASK-FORCE
COMPUTED-TOMOGRAPHY
BIMODAL PATTERN
AT-RISK
SIZE
ISCHEMIA/REPERFUSION
QUANTIFICATION
Dynamic Edematous Response of the Human Heart to Myocardial Infarction Implications for Assessing Myocardial Area at Risk and Salvage
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