Burchell, Tom

Davies, L Ceri

Locca, Didier

Mathur, Anthony

Mohiddin, Saidi A

Pain, Tom

Petersenl, Steffen E

Schwitter, Juerg

Westwood, Mark A

English

PubMed

Tom Burchell

Tom Pain

Saidi A Mohiddin

Didier Locca

L Ceri Davies

Steffen E Petersenl

Juerg Schwitter

Anthony Mathur

Mark A Westwood

Crossref

POSTER PRESENTATION Open AccessThe regression of myocardial oedema in the first3 months post ST-elevation MI in patients treatedwith primary angioplastyTom Burchell1*, Tom Pain1, Saidi A Mohiddin1, Didier Locca2, L Ceri Davies1, Steffen E Petersenl1, Juerg Schwitter2,Anthony Mathur1, Mark A Westwood1From 2011 SCMR/Euro CMR Joint Scientific SessionsNice, France. 3-6 February 2011BackgroundMyocardial oedema and salvaged area at risk (ARA)have been described as markers of prognosis and as sur-rogate markers for clinical trials. The time-course ofoedema has been described in a canine infarct modelbut the in vivo time course following revascularised MIhas not been described. CMR is able to characteriseoedema in myocardial tissue using T2-weightedsequences. We therefore aimed to determine the time-course of post infarct myocardial oedema using serialCMR imaging.Methods9 patients with acute ST-elevation MI who underwentprimary PCI with stent implantation within 12 hours ofsymptom onset were recruited. Patients were scanned ondays 1, 3, 10, 20 and 90 following their PPCI with a 1.5TPhilips Achieva (Philips Medical Systems). Images wereobtained as continuous short-axis stacks covering the leftventricle with a slice thickness of 8mm and gap of 2mm.Myocardial oedema was assessed at all time points usingT2-weighted triple inversion turbo spin echo STIR ima-ging (TE 80, TR 1667). Scans performed on days 3 and90 included assessment of scar after administration of abolus of Gadodoteric acid (0.15 mmol/kg) using a T1-weighted TFE sequence. Image analysis was performedusing dedicated software, CMR42 (Circle CVI, Calgary,Canada). Scar and oedema volumes were calculated bymanually drawing endocardial and epicardial contoursfollowed by semi-automated selection of normal remotemyocardium per slice. The scar and oedema weredescribed as >5SD and >2SD in signal intensity fromremote normal myocardium respectively. Values areexpressed as a percentage of the LV mass (%LVM).1London Chest Hospital, London, UKFull list of author information is available at the end of the articleFigure 1Burchell et al. Journal of Cardiovascular Magnetic Resonance 2011, 13(Suppl 1):P132http://jcmr-online.com/content/13/S1/P132© 2011 Burchell et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative CommonsAttribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction inany medium, provided the original work is properly cited.ResultsPatient age was 56.6 ± 5.4 years (88% male). Myocardialoedema peaks at day 3 (31.1 ± 4.3%LVM) and is signifi-cantly greater than the area of scar (13.7 ± 4.5%LVM)p=<0.0001, with an average salvaged ARA of 17.3 ±5.7%. There is no difference in oedema between days 1and 3 or days 10 and 20. There was a reduction of 8%in oedema between days 3 and 10 (p=0.0003, 95% CI2.8 - 13.1). Oedema persists at 90 days and is the samesize as the scar (10.6 ± 6% vs. 10 ± 5.1% p=ns). Figure 1.ConclusionsMyocardial oedema post myocardial infarction peaks atday 3 and persists for 90 days. There is no significantchange between days 10-20 which may provide the mostappropriate time period to assess myocardial oedema.Myocardial oedema may also persist much longer thanpreviously thought.Author details1London Chest Hospital, London, UK. 2Lausanne University Hospital,Lausanne, Switzerland.Published: 2 February 2011doi:10.1186/1532-429X-13-S1-P132Cite this article as: Burchell et al.: The regression of myocardial oedemain the first 3 months post ST-elevation MI in patients treated withprimary angioplasty. Journal of Cardiovascular Magnetic Resonance 201113(Suppl 1):P132.Submit your next manuscript to BioMed Centraland take full advantage of: • Convenient online submission• Thorough peer review• No space constraints or color figure charges• Immediate publication on acceptance• Inclusion in PubMed, CAS, Scopus and Google Scholar• Research which is freely available for redistributionSubmit your manuscript at www.biomedcentral.com/submitBurchell et al. Journal of Cardiovascular Magnetic Resonance 2011, 13(Suppl 1):P132http://jcmr-online.com/content/13/S1/P132Page 2 of 2

Journal of Cardiovascular Magnetic Resonance

The regression of myocardial oedema in the first 3 months post ST-elevation MI in patients treated with primary angioplasty

L Davies

Springer - Publisher Connector

POSTER PRESENTATION Open Access
The regression of myocardial oedema in the first
3 months post ST-elevation MI in patients treated
with primary angioplasty
Tom Burchell1*, Tom Pain1, Saidi A Mohiddin1, Didier Locca2, L Ceri Davies1, Steffen E Petersenl1, Juerg Schwitter2,
Anthony Mathur1, Mark A Westwood1
From 2011 SCMR/Euro CMR Joint Scientific Sessions
Nice, France. 3-6 February 2011
Background
Myocardial oedema and salvaged area at risk (ARA)
have been described as markers of prognosis and as sur-
rogate markers for clinical trials. The time-course of
oedema has been described in a canine infarct model
but the in vivo time course following revascularised MI
has not been described. CMR is able to characterise
oedema in myocardial tissue using T2-weighted
sequences. We therefore aimed to determine the time-
course of post infarct myocardial oedema using serial
CMR imaging.
Methods
9 patients with acute ST-elevation MI who underwent
primary PCI with stent implantation within 12 hours of
symptom onset were recruited. Patients were scanned on
days 1, 3, 10, 20 and 90 following their PPCI with a 1.5T
Philips Achieva (Philips Medical Systems). Images were
obtained as continuous short-axis stacks covering the left
ventricle with a slice thickness of 8mm and gap of 2mm.
Myocardial oedema was assessed at all time points using
T2-weighted triple inversion turbo spin echo STIR ima-
ging (TE 80, TR 1667). Scans performed on days 3 and
90 included assessment of scar after administration of a
bolus of Gadodoteric acid (0.15 mmol/kg) using a T1-
weighted TFE sequence. Image analysis was performed
using dedicated software, CMR42 (Circle CVI, Calgary,
Canada). Scar and oedema volumes were calculated by
manually drawing endocardial and epicardial contours
followed by semi-automated selection of normal remote
myocardium per slice. The scar and oedema were
described as >5SD and >2SD in signal intensity from
remote normal myocardium respectively. Values are
expressed as a percentage of the LV mass (%LVM).
1London Chest Hospital, London, UK
Full list of author information is available at the end of the article
Figure 1
Burchell et al. Journal of Cardiovascular Magnetic Resonance 2011, 13(Suppl 1):P132
http://jcmr-online.com/content/13/S1/P132
© 2011 Burchell et al; licensee BioMed Central Ltd. 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.
Results
Patient age was 56.6 ± 5.4 years (88% male). Myocardial
oedema peaks at day 3 (31.1 ± 4.3%LVM) and is signifi-
cantly greater than the area of scar (13.7 ± 4.5%LVM)
p=<0.0001, with an average salvaged ARA of 17.3 ±
5.7%. There is no difference in oedema between days 1
and 3 or days 10 and 20. There was a reduction of 8%
in oedema between days 3 and 10 (p=0.0003, 95% CI
2.8 - 13.1). Oedema persists at 90 days and is the same
size as the scar (10.6 ± 6% vs. 10 ± 5.1% p=ns). Figure 1.
Conclusions
Myocardial oedema post myocardial infarction peaks at
day 3 and persists for 90 days. There is no significant
change between days 10-20 which may provide the most
appropriate time period to assess myocardial oedema.
Myocardial oedema may also persist much longer than
previously thought.
Author details
1London Chest Hospital, London, UK. 2Lausanne University Hospital,
Lausanne, Switzerland.
Published: 2 February 2011
doi:10.1186/1532-429X-13-S1-P132
Cite this article as: Burchell et al.: The regression of myocardial oedema
in the first 3 months post ST-elevation MI in patients treated with
primary angioplasty. Journal of Cardiovascular Magnetic Resonance 2011
13(Suppl 1):P132.
Submit your next manuscript to BioMed Central
and take full advantage of: 
• Convenient online submission
• Thorough peer review
• No space constraints or color figure charges
• Immediate publication on acceptance
• Inclusion in PubMed, CAS, Scopus and Google Scholar
• Research which is freely available for redistribution
Submit your manuscript at 
www.biomedcentral.com/submit
Burchell et al. Journal of Cardiovascular Magnetic Resonance 2011, 13(Suppl 1):P132
http://jcmr-online.com/content/13/S1/P132
Page 2 of 2


Schwitter Juerg

Petersenl Steffen E

Davies L

Locca Didier

Mohiddin Saidi A

Pain Tom

Burchell Tom

Mathur Anthony

Westwood Mark A

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The regression of myocardial oedema in the first 3 months post ST-elevation MI in patients treated with primary angioplasty

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