Fairbairn, Timothy

Greenwood, John P

Kidambi, Ananth

Mather, Adam N

Motwani, Manish

Plein, Sven

Swoboda, Peter

English

PubMed

Ananth Kidambi

Adam N Mather

Peter Swoboda

Manish Motwani

Timothy Fairbairn

John P Greenwood

Sven Plein

Springer - Publisher Connector

ORAL PRESENTATION Open Access
Recovery of regional myocardial function and
myocardial oedema following reperfused acute
myocardial infarction
Ananth Kidambi1*, Adam N Mather2,1, Peter Swoboda1, Manish Motwani1, Timothy Fairbairn1, John P Greenwood1,
Sven Plein1
From 15th Annual SCMR Scientific Sessions
Orlando, FL, USA. 2-5 February 2012
Summary
We investigated the relationship between myocardial
oedema and recovery of regional myocardial function in
patients with acute reperfused myocardial infarction
(MI).
Early after acute MI, oedema in the peri-infarct zone,
as delineated by T2 weighted (T2w) cardiovascular mag-
netic resonance (CMR) imaging, demonstrated signifi-
cantly reduced strain as compared to remote
myocardium. The recovery of regional function in the
peri-infarct zone closely followed the resolution of
hyperenhancement on T2w CMR. In addition, both
transmural and subendocardial infarcts showed a degree
of functional recovery after acute MI.
Background
Myocardial tissue oedema is a feature of acute reper-
fused myocardial infarction, and contributes to stunning
of viable peri-infarct myocardium (the ‘area at risk’).
Regression of oedema on T2w CMR imaging is related
to improved myocardial contractility post MI in animal
models. Whether a similar relationship between myocar-
dial oedema and regional myocardial function exists in
man is not currently known. We hypothesised that the
resolution of tissue oedema correlates with recovery of
regional contractile function.
Methods
We studied patients after primary percutaneous coron-
ary intervention for first ST-elevation MI. Patients
underwent CMR with T2w, myocardial tagging and late
gadolinium enhancement imaging at median 2, 30 and
90 days post reperfusion. Infarct size, regional circum-
ferential strain, intensity and volume of myocardial
oedema were measured for infarct zone, peri-infarct
zone (area at risk) and remote myocardium. Oedema
and infarction were defined as zones with signal inten-
sity 2 standard deviations above remote myocardium in
T2w and LGE imaging respectively. T2w signal intensity
was corrected using a ratio to remote myocardium.
Results
Thirty patients had CMR imaging at all three time
points and had adequate image quality with sufficient
peri-infarct oedema for quantitative analysis. Circumfer-
ential strain was significantly diminished in infarct and
peri-infarct zones compared to remote myocardium
(means -0.149 vs. -0.184 vs. -0.236, P<0.01 between
groups and P<0.01 for trend). Remote myocardium
showed no significant change in strain over time
(F=1.44, P=0.24), whilst the peri-infarct zone (F=6.03,
P=0.004) and infarct zone (F=20.34, P<0.001) showed a
significant increase in magnitude. This change closely
mirrored resolution of both intensity and volume of T2
hyperenhancement (Figure 1). Decreased circumferential
strain correlated significantly with T2 volume (r=0.30;
P<0.01) and corrected T2 signal intensity (r=0.28;
P<0.01).
Due to the unexpected finding of recovery of function
in the infarct zone, we analysed the 8 patients with
complete transmural infarction. The area of fully trans-
mural infarction showed a trend towards significant
resolution of strain with time (means -0.103 (day 2),
-0.148 (day 30) and -0.194 (day 90); P=0.050 for trend).
1Multidisciplinary Cardiovascular Research Centre & Leeds Institute of
Genetics, Health and Therapeutics, University of Leeds, Leeds, UK
Full list of author information is available at the end of the article
Kidambi et al. Journal of Cardiovascular Magnetic Resonance 2012, 14(Suppl 1):O64
http://www.jcmr-online.com/content/14/S1/O64
© 2012 Kidambi 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.
Conclusions
In the setting of acute reperfused MI, improvement of
strain in stunned myocardium closely follows the regres-
sion of myocardial oedema. Patients with larger oedema
volumes and higher signal intensity on T2w imaging
demonstrated greater improvement of strain within the
area at risk. Strain imaging reveals recovery of function
within transmurally infarcted myocardium. Volume and
intensity of hyperenhancement on T2w CMR in the
area at risk may give insights into functional recovery
post reperfused MI.
Funding
S.P is funded by British Heart Foundation fellowship
(FS/10/62/28409).
S.P and J.P.G receive a research grant from Philips
Healthcare.
Author details
1Multidisciplinary Cardiovascular Research Centre & Leeds Institute of
Genetics, Health and Therapeutics, University of Leeds, Leeds, UK. 2Hull &
East Yorkshire Cardiothoracic Centre, Castle Hill Hospital, Kingston-upon-Hull,
UK.
Published: 1 February 2012
doi:10.1186/1532-429X-14-S1-O64
Cite this article as: Kidambi et al.: Recovery of regional myocardial
function and myocardial oedema following reperfused acute
myocardial infarction. Journal of Cardiovascular Magnetic Resonance 2012
14(Suppl 1):O64.
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Figure 1 Change in strain, T2 hyperenhancement intensity, and peri-infarct myocardial volume (area at risk) in the peri-infarct zone.
Kidambi et al. Journal of Cardiovascular Magnetic Resonance 2012, 14(Suppl 1):O64
http://www.jcmr-online.com/content/14/S1/O64
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Recovery of regional myocardial function and myocardial oedema following reperfused acute myocardial infarction

Recovery of regional myocardial function and myocardial oedema following reperfused acute myocardial infarction

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