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Infarct size and myocardial function: A methodological study
Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences.
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The size of a myocardial infarction (MI) and the concurrent effect on left ventricular (LV) function are essential for decisions regarding patient care and treatment. Images produced with the late gadolinium enhancement (LGE) technique visualize the scar with high spatial resolution. The general aim of this thesis was to study methods to assess scar size in chronic MI, primarily with the use of LGE, and to relate area‐at‐risk and LV function to scar size.

Myocardial perfusion single photon emission computed tomography (MPS) is a well established technique for the assessment of MI size. Our study showed that there is a fairly good agreement between MPS and LGE in the determination of scar size. Wall motion score index (WMSI) correlated moderately with both infarct size and infarct extent determined with LGE.

Manual delineation of myocardium and scar is time consuming and subjective and there is a need for help in objective assessment. We showed that the semi‐automatic computer software, Segment, reduced the evaluation time ≥50% with maintained clinical accuracy.

The segmented scar sequence ‐ inversion recovery fast gradient echo, IR_FGRE, is a well documented sequence for scar determination, however, the sequence requires regular heart rhythm and breath holding for good imaging. We showed that a single shot scar sequence ‐ steady state free precession, SS_SSFP ‐ acquired under free breathing in patients with ongoing atrial fibrillation, had significantly better image quality than IR_FGRE. The scar size and the error of determination were equal for both sequences and the examination time was shorter with SS_SSFP.

In an acute MI it is essential to know the myocardial area‐at‐risk. WMSI is clinically the most common way of assessing LV function, but is highly subjective. Tissue Doppler imaging with strain measurements is considered objective and quantitative in assessing both global and regional LV function compared to WMSI. Our results showed that WMSI is superior to strain for the detection of scar with transmurality ≥50% in patients with acute MI. Also WMSI correlated better than strain on all levels (global, regional, segmental) with final scar size determined with LGE.

LGE images visualize myocardial scar much more distinctly than any other modality. This new technique needs clinical validation but promises intense competition with existing modalities such as myocardial scintigraphy and echocardiography.

However, in individual patient care all modalities should be used according to their own advantages and limitation.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press , 2010. , 85 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1169
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-53943ISBN: 9789173934374 (print)OAI: oai:DiVA.org:liu-53943DiVA: diva2:302693
Public defence
2010-03-26, Originalet, Qulturum, Hus B4, Länssjukhuset Ryhov, Jönköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2010-03-09 Created: 2010-02-15 Last updated: 2017-12-13Bibliographically approved
List of papers
1. Late gadolinium uptake demonstrated with magnetic resonance in patients where automated PERFIT analysis of myocardial SPECT suggests irreversible perfusion defect.
Open this publication in new window or tab >>Late gadolinium uptake demonstrated with magnetic resonance in patients where automated PERFIT analysis of myocardial SPECT suggests irreversible perfusion defect.
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2008 (English)In: BMC Medical Imaging, ISSN 1471-2342, E-ISSN 1471-2342, Vol. 8Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-44950 (URN)78430 (Local ID)78430 (Archive number)78430 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13
2. Computer-assisted calculation of myocardial infarct size shortens the evaluation time of contrast-enhanced cardiac MRI
Open this publication in new window or tab >>Computer-assisted calculation of myocardial infarct size shortens the evaluation time of contrast-enhanced cardiac MRI
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2008 (English)In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 28, no 1Article in journal (Refereed) Published
Abstract [en]

Background: Delayed enhancement magnetic resonance imaging depicts scar in the left ventricle which can be quantitatively measured. Manual segmentation and scar determination is time consuming. The purpose of this study was to evaluate a software for infarct quantification, to compare with manual scar determination, and to measure the time saved. Methods: Delayed enhancement magnetic resonance imaging was performed in 40 patients where myocardial perfusion single photon emission computed tomography imaging showed irreversible uptake reduction suggesting a myocardial scar. After segmentation, the semi-automatic software was applied. A scar area was displayed, which could be corrected and compared with manual delineation. The different time steps were recorded with both methods. Results: The software shortened the average evaluation time by 12.4min per cardiac exam, compared with manual delineation. There was good correlation of myocardial volume, infarct volume and infarct percentage (%) between the two methods, r = 0.95, r = 0.92 and r = 0.91 respectively. Conclusions: A computer software for myocardial volume and infarct size determination cut the evaluation time by more than 50% compared with manual assessment, with maintained clinical accuracy. © 2007 The Authors Journal compilation 2007 Blackwell Publishing Ltd.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-42739 (URN)10.1111/j.1475-097X.2007.00765.x (DOI)68501 (Local ID)68501 (Archive number)68501 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13
3. Image quality and myocardial scar size determined with magnetic resonance imaging in patients with permanent atrial fibrillation: a comparison of two imaging protocols
Open this publication in new window or tab >>Image quality and myocardial scar size determined with magnetic resonance imaging in patients with permanent atrial fibrillation: a comparison of two imaging protocols
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2010 (English)In: CLINICAL PHYSIOLOGY AND FUNCTIONAL IMAGING, ISSN 1475-0961, Vol. 30, no 2, 122-129 p.Article in journal (Refereed) Published
Abstract [en]

Pandgt;Background: Magnetic resonance imaging (MRI) of the heart generally requires breath holding and a regular rhythm. Single shot 2D steady-state free precession (SS_SSFP) is a fast sequence insensitive to arrhythmia as well as breath holding. Our purpose was to determine image quality, signal-to-noise (SNR) and contrast-to-noise (CNR) ratios and infarct size with a fast single shot and a standard segmented MRI sequence in patients with permanent atrial fibrillation and chronic myocardial infarction. Methods: Twenty patients with chronic myocardial infarction and ongoing atrial fibrillation were examined with inversion recovery SS_SSFP and segmented inversion recovery 2D fast gradient echo (IR_FGRE). Image quality was assessed in four categories: delineation of infarcted and non-infarcted myocardium, occurrence of artefacts and overall image quality. SNR and CNR were calculated. Myocardial volume (ml) and infarct size, expressed as volume (ml) and extent (%), were calculated, and the methodological error was assessed. Results: SS_SSFP had significantly better quality scores in all categories (P = 0 center dot 037, P = 0 center dot 014, P = 0 center dot 021, P = 0 center dot 03). SNRinfarct and SNRblood were significantly better for IR_FGRE than for SS_SSFP (P = 0 center dot 048, P = 0 center dot 018). No significant difference was found in SNRmyocardium and CNR. The myocardial volume was significantly larger with SS_SSFP (170 center dot 7 versus 159 center dot 2 ml, P andlt; 0 center dot 001), but no significant difference was found in infarct volume and infarct extent. Conclusion: SS_SSFP displayed significantly better image quality than IR_FGRE. The infarct size and the error in its determination were equal for both sequences, and the examination time was shorter with SS_SSFP.

Keyword
atrial fibrillation, magnetic resonance imaging, myocardial infarction, segmented inversion recovery 2D fast gradient echo, single shot inversion recovery 2D steady-state free precession
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-54159 (URN)10.1111/j.1475-097X.2009.00914.x (DOI)000274438800006 ()
Available from: 2010-02-26 Created: 2010-02-26 Last updated: 2016-08-24
4. Longitudinal peak strain detects a smaller risk area than visual assessment of wall motion in acute myocardial infarction
Open this publication in new window or tab >>Longitudinal peak strain detects a smaller risk area than visual assessment of wall motion in acute myocardial infarction
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2010 (English)In: Cardiovascular ultrasound, ISSN 1476-7120, Vol. 8, no 2, 1-12 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Opening of an occluded infarct related artery reduces infarct size and improves survival in acute ST-elevation myocardial infarction (STEMI). In this study we performed tissue Doppler analysis (peak strain, displacement, mitral annular movement (MAM)) and compared with visual assessment for the study of the correlation of measurements of global, regional and segmental function with final infarct size and transmurality. In addition, myocardial risk area was determined and a prediction sought for the development of infarct transmurality >or=50%.

METHODS: Twenty six patients with STEMI submitted for primary percutaneous coronary intervention (PCI) were examined with echocardiography on the catheterization table. Four to eight weeks later repeat echocardiography was performed for reassessment of function and magnetic resonance imaging for the determination of final infarct size and transmurality.

RESULTS: On a global level, wall motion score index (WMSI), ejection fraction (EF), strain, and displacement all showed significant differences (p or=50%, but strain added no significant information to that obtained with WMSI in a logistic regression analysis.

CONCLUSIONS: In patients with acute STEMI, WMSI, EF, strain, and displacement showed significant changes between the pre- and post PCI exam. In a ROC-analysis, strain had 64% sensitivity at 80% specificity and WMSI around 90% sensitivity at 80% specificity for the detection of scar with transmurality >or=50% at follow-up.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-54292 (URN)10.1186/1476-7120-8-2 (DOI)000275201700001 ()20064264 (PubMedID)
Note

Original Publication: Lene Rosendahl, Peter Blomstrand, Lars Brudin, Tim Tödt and Jan E Engvall, Longitudinal peak strain detects a smaller risk area than visual assessment of wall motion in acute myocardial infarction, 2010, Cardiovascular ultrasound, (8), 2, 1-12. http://dx.doi.org/10.1186/1476-7120-8-2 Licensee: BioMed Central http://www.biomedcentral.com/

Available from: 2010-03-08 Created: 2010-03-08 Last updated: 2014-01-17Bibliographically approved

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