肥厚型心肌病延迟增强磁共振成像与心律失常的相关性

目的 探讨肥厚型心肌病延迟增强磁共振成像(MRI)显示的心肌纤维化与心律失常的相关性.方法 对48例未经治疗的肥厚型心肌病患者进行了MRI心功能分析、钆喷替酸葡甲胺(Gd-DTPA)延迟增强MRI、常规心电图和24 b动态心电图检查.分别探讨延迟增强MRI与频发室性期前收缩(PVCS总数≥200个)、阵发性室上性心动过速(SVT)、非持续性室性心动速(NSVT)、房室传导阻滞(AVB)、室内传导阻滞(IVB)之间的关系.计算延迟强化心肌质量、延迟强化心肌质量百分比,并分析其与24 h内PVCS、SVT和NSVT总数,传导阻滞(PR间期、QRS时限)间的相关性.描述肥厚型心肌病延迟强化节段的分布和特征.结果 48例肥厚型心肌病患者中35例出现延迟强化.出现PVCS、SVT、NSVT、AVB、IVB等心律失常的肥厚型心肌病患者中,延迟增强阳性患者出现PVCS、SVT、NSVT的数目显著大于延迟增强阴性患者(P=0.001～0.03).延迟强化心肌质量百分比与QRS时限呈正相关(r=0.33,P＜0.001).结论 延迟增强MRI显示的心肌纤维化与心律失常相关,可能为存在(或潜在)并发心律失常的肥厚型心肌病患者提供更多评估病情和预后的信息.     

MRI心肌成像技术在心肌梗死后存活心肌中的诊断价值

目的探讨MRI心肌成像技术在心肌梗死后存活心肌诊断中的价值。方法采用1.5TGE Signa CV/iMRI对20例临床确诊为心肌梗死并经冠脉造影证实有心肌缺血的患者进行扫描。采用真正快速稳态梯度回波序列(FIESTA)完成心脏长轴面和短轴面的心脏运动MRI电影采集;快速梯度回波序列(FGREET)完成心肌灌注首过时相MRI图像采集;反转恢复梯度回波序列(MDE)完成心肌灌注延迟时相MRI图像采集。结果首过灌注减低区和延迟增强区与同层面正常区域心肌的时间-信号强度曲线的最大上升斜率(slope)差别显著(分别为t=12.9,P<0.001;t=14.3,P<0.001)。首过期灌注减低12例(60%),延迟期心肌增强19例(95%),延迟强化范围明显大于首过灌注缺损区。多因素线性回归分析显示,延迟强化的范围和与其运动能力呈负相关。结论多种MRI成像序列的应用为正确地评价心肌梗死后存活心肌提供了可靠的方法。     

心尖肥厚型心肌病病人MRI表现及心电图特点分析

目的研究心尖肥厚型心肌病MRI表现和心电图的特点,探讨MRI在心肌肥厚型心肌病中的诊断价值。方法对临床确诊的26例心尖肥厚型心肌病病人MRI表现、心电图资料进行回顾分析。结果 26例病人心脏MRI均提示心尖部心肌肥厚,TAHCM14例,P-AHCM12例,8例T-AHCM舒张期左室表现为典型的"黑桃心"征象。26例病人行心肌首过灌注及延迟强化MRI扫描,11例延迟增强显示心尖部肥厚心肌内不规则增强高信号。26例病人心电图均存在ST-T改变:其中26例左胸导联产生的对称倒置的T波,11例表现为巨大T波倒置(42.3%);16例表现胸前导联R波振幅增高(61.5%);17例出现ST段下移(65.4%);T波倒置深度与心尖部室壁厚度无相关性,但T-AHCM、P-AHCM两组11例延迟强化阳性病例,均表现为巨大T波倒置,两组肥厚心肌的延迟增强阳性率无统计学意义。结论在心尖肥厚型心肌病中,MRI可以准确诊断,延迟强化能够解释心电图中巨大倒置T波原因。     

比较小剂量多巴酚丁胺负荷磁共振评价陈旧性心肌梗死和心肌活性的联系

目的:比较小剂量多巴酚丁胺负荷磁共振(MRI)和延迟强化MRI评价陈旧性心肌梗死和心肌活性的价值。方法:25例陈旧性心肌梗死患者于血运重建前行静息及小剂量多巴酚丁胺负荷(5～10μg.kg-1.min-1)心脏电影MRI和延迟强化心脏MRI,小剂量多巴酚丁胺负荷MRI存活心肌的定义为:≥2个相邻的静息期无运动及反向运动的节段,负荷后节段心肌收缩≥2 mm;延迟强化透壁程度分为5个等级评分,分别为无强化(0分),0～25%(1分),25%～50%(2分),50%～75%(3分),75%～100%(4分),节段心肌评分≤2为预测心功能可恢复。结果:延迟强化透壁程度≤50%的心肌节段(评分0～2),89%多巴酚丁胺负荷阳性;延迟强化透壁程度≥75%的心肌节段(评分4),21%多巴酚丁胺负荷阳性(P0.05)。延迟强化透壁程度在50%～75%(评分3)之间时,54%多巴酚丁胺负荷阳性,46%多巴酚丁胺负荷阴性。结论:当延迟强化为心内膜下强化和透壁强化时,与多巴酚丁胺负荷一致性好。当延迟强化透壁程度在50%～75%(评分3)之间时,需要进一步进行多巴酚丁胺负荷以更好地预测心肌活性。     

磁共振成像对冠心病陈旧性心肌梗死所致心功能不全的诊断及干细胞移植疗效评价的应用

目的 评价磁共振成像(MRI)在冠心病陈旧性心肌梗死合并心功能不全患者诊断中的价值,并分析干细胞移植手术的疗效.方法 20例冠心病陈旧性心肌梗死患者,男18例,女2例,年龄(59.5±10.1)岁,半均分成2组(每组10例),干细胞移植组行冠状动脉旁路移植术(CABG)+干细胞移植,对照组仅行CABG术,术前均行心脏MRI及双核素单光子发射计算机断层(SPECT)进行存活心肌显像检查,术后6个月复查心脏MRI.用MRI评价干细胞移植后左心功能改善及心脏MRI延迟增强显像判断左室存活心肌的准确性.结果 两组左室射血分数(LVEF)均有明显改善,但手术前后变化值比较差异无统计学意义.干细胞移植组左室舒张末期容积(LVEDV)手术前后变化值为(9.91±39.50)ml,与对照组的(-22.34±31.35)ml比较,差异有统计学意义(P＜0.05);干细胞移植组窒壁增厚率变化值高于对照组(11.40%±11.53%比2.27%±7.20%,P＜0.05),其余两组心功能参数变化值比较差异均无统计学意义.心脏MRI延迟增强显像与氟-18-脱氧葡萄糖(18F-FDG)心肌代谢存活心肌显像具有较好的一致性,Kappa=0.446(P＜0.001).以18F-FDG SPECT心肌代谢显像为金标准,心脏MRI延迟增强显像敏感度为68.3%,特异度为92.5%.结论 MRI能够准确判断冠心病陈旧性心肌梗死患者左室容积和功能,对心肌梗死后存活心肌的判断具有同18F-FDG SPECT相近的特异性,但敏感件略低.MRI可用于心肌十细胞移植前诊断与移植后早期疗效的判定.     

磁共振成像在异位心脏移植中的应用价值

目的应用MRI观察冠状动脉旁路移植术联合室壁瘤切除术+异位心脏移植术后心脏结构、功能等变化。方法对5例行自体心脏冠状动脉旁路移植术联合室壁瘤切除术+异位心脏移植术患者,采用1.5T超导MRI扫描仪对心脏形态、功能、心肌灌注、延迟增强等进行综合评价。3例术前行MRI检查,5例术后1～17个月先后3次行心脏MRI扫描。结果5例患者术后临床症状均明显改善。3例手术后自体心脏左心室腔均较术前缩小,仅1例心功能明显提高,LVEF从18.4%提高到47.2%。移植术后5例患者中2例自体心脏左心室功能明显改善,LVEF分别上升至47.2%和52.1%,其供体心脏左心室收缩功能低下,LVEF分别为18.4%和22%;3例自体心脏功能恢复不佳的患者,供体心脏左心室收缩功能良好。所有供体心脏心肌首过灌注与延迟增强均无异常信号;所有自体心脏心肌首过灌注与延迟增强均无显著变化。结论MRI一站式无创性检查方法是异位心脏移植术较理想的评估方法。     

3.0T MR心肌灌注成像技术应用体会

目的探讨3.0T MR心肌灌注成像(MR myocardial perfusion imaging MRMPI)检查技术应用及方法。方法对25例冠脉CTA确诊的冠心病患者行MR首过心肌灌注、延迟增强成像,经两位高年资医师以双盲法对图像质量进行评价分析。结果 21例图像质量达到诊断要求,21例受检者狭窄度≥50%的冠脉共34支中,29支显示首过灌注减低,9支显示延迟增强,其中心肌透壁增强4例,非透壁增强5例。4例图像质量不能达到诊断要求。结论在控制好受检者心率及呼吸,掌控好技术要点的情况下,MR心肌灌注成像完全可以得到符合诊断要求的图像,有效评价心肌缺血情况及程度,为冠心病的临床诊断及合理治疗提供可靠的依据。     

心脏增强磁共振成像评价临床患者心肌活性的实验研究

目的:评价磁共振成像(MRI)对陈旧性心肌梗死(old myocardial infarction,OMI)患者心肌活性的诊断价值。方法:分析13例OMI患者的增强磁共振(contrast enhanced magnetic resonance ima-ging,ceMRI)延迟强化透壁率、冠状动脉造影TIMI分级结果和心肌双核素显像(single-photon emissioncomputed tomography,SPECT)心肌存活情况。将13例OMI患者ceMRI透壁率、冠状动脉造影TIMI分级和SPECT心肌存活情况进行受试者工作曲线(ROC)分析。结果:ceMRI透壁率曲线下面积为0.953,冠状动脉造影TIMI分级曲线下面积为0.935,ceMRI透壁率与金标准心肌双核素显像相比,透壁率在26%～50%诊断存活心肌的灵敏度为88.9%,特异度为82.7%;透壁率在51%～75%诊断存活心肌的灵敏度为74.1%,特异度为98.7%,与心肌双核素显像相比其诊断的准确性较高。结论:增强MRI清晰显示心肌梗死的位置、范围和程度。ceMRI透壁率诊断存活心肌的准确性较高。     

多层螺旋CT评估心功能及心肌活性的研究进展

多层螺旋CT已迅速发展成为心脏无创检查的重要方法之一。已有研究证实其在定量冠状动脉钙化负荷、评价冠状动脉粥样斑块形态和组成等方面的应用。现综述多层螺旋CT心肌灌注显像和心肌延迟增强评估心功能、心室壁运动和心肌活性等功能方面的研究进展。     

多排对比增强螺旋CT评价心肌存活性的研究进展

心肌梗死后心肌存活性的判定可以预测功能受损心肌在血运重建后的功能恢复,对制定心肌再灌注策略具有重要意义.多层螺旋CT(MSCT)评价冠状动脉病变的价值已得到普遍肯定.在静脉注射造影剂后5～15 min行此检查称为延迟增强MSCT(DE-MSCT).动物实验和临床研究均证实DE-MSCT评价心肌活性与核磁共振、单光子发射计算机体层摄影、正电子发射体层摄影等检查有很好的相关性,具有广阔的应用前景.     

实时心肌超声造影与磁共振心肌灌注延迟增强检测存活心肌的比较

目的评价实时心肌超声造影(RT-MCE)与磁共振心肌灌注延迟增强(DE-MRI)检测存活心肌的临床价值。方法入选2012年7月至2013年12月徐州矿务集团总医院(徐州医学院第二附属医院)心内科收治入院的冠状动脉粥样硬化性心脏病(冠心病)患者27例,男性16例,女性11例,平均年龄62.5岁。所有患者行RT-MCE、DE-MRI、冠状动脉造影(CAG)及冠状动脉介入治疗(PCI)。对患者的RT-MCE图像分析采用目测半定量法,判定存活心肌;对心肌灌注延迟增强情况进行分级,根据分级结果对心肌存活情况进行判定。术后1、3、6月时复查心脏超声,以冠状动脉血运重建后室壁节段收缩功能改善为判断存活心肌的金标准。结果 RT-MCE目测半定量法检测存活心肌的灵敏性、特异性及准确度分别是70.9%、85.7%、76.3%;DE-MRI法检测存活心肌的灵敏性、特异性及准确度分别是72.7%、76.2%、74.0%,RT-MCE目测半定量法检测存活心肌较DE-MRI法具有较高的特异度(76.2%vs.85.7%,P0.05)。两种检测方法的相关性良好。结论 RT-MCE目测半定量法与DE-MRI法检测存活心肌具有较高的临床价值,RT-MCE目测半定量法具有更高的特异性。     

Technology insight: assessment of myocardial viability by delayed-enhancement magnetic resonance imaging

Myocardial viability is of established importance to the management of cardiac patients being considered for revascularization. Existing noninvasive imaging tests to examine myocardial viability, such as stress echocardiography and nuclear scintigraphy, are of recognized utility but are subject to intrinsic limitations. Over the past few years delayed-enhancement MRI (DE-MRI) has emerged as an alternative to traditional tests and for the first time allows direct visualization of the transmural extent of myocardial viability. In this paper we review the scientific data that underlie the use of DE-MRI in patients with ischemic heart disease. Progress in this area is largely the result of the development of a new MRI pulse sequence in the late 1990s, which improved the detection of necrotic and scarred myocardial tissue. Following this technical development, a series of detailed histologic comparisons in large animal models revealed that both acute and healed myocardial infarcts appeared as brighter (hyperenhanced) areas than viable regions, and that the effect is independent of contractile function. The resulting 'bright is dead' hypothesis has thus far proven of significant use in patients with ischemic heart disease. Data are now emerging which suggest that the DE-MRI technique also has important implications for patients with nonischemic forms of cardiomyopathy.     

Findings on magnetic resonance imaging of fascicular ventricular tachycardia

Background

Idiopathic left ventricular tachycardia (ILVT) with right bundle branch block and left axis deviation originates from the left posterior fascicle—Purkinje fiber network. Scar-related ventricular tachycardias (VTs) with Purkinje fibers as a part of the reentry circuit have also been described in patients with structural heart disease.

Methods and results

Nine patients with fascicular VT (left posterior, n?=?8; left anterior, n?=?1) with preserved left ventricular ejection fraction (60?±?10 %) underwent cardiac magnetic resonance imaging (MRI) including functional analysis and delayed enhancement magnetic resonance imaging (DE-MRI). No definite structural abnormalities were detected by DE-MRI in four patients. DE-MRI revealed unifocal or multifocal areas of fibrosis or scar in three patients corresponding to the regions where typical Purkinje potentials guided successful ablation of the sustained fascicular VT. A false tendon extending from the free wall to the septum was found in one patient. Moderate reduction of left ventricular ejection fraction associated with septal or multifocal left ventricular fibrosis was detected in two patients with ventricular bigeminy originating from the left posterior fascicle. During the follow-up of 29?±?22 months after successful catheter ablation in the nine patients, one patient with septal fibrosis detected by DE-MRI had VT recurrence and received an implantable cardioverter defibrillator.

Conclusion

Detection of local areas of fibrosis or scar by DE-MRI may help to distinguish idiopathic fascicular tachycardia from scar-related fascicular VT in patients with preserved left ventricular function.     

Extent of myocardial scarring on nonstress delayed-contrast-enhancement cardiac magnetic resonance imaging correlates directly with degrees of resting regional dysfunction in chronic ischemic heart disease

Background

Hyper-enhancement on delayed-enhancement magnetic resonance imaging (DE-MRI) is a marker of irreversible myocardial injury. Both reversible and irreversible ischemically injured regions of myocardium develop reductions in systolic function compared with unaffected regions. This study evaluated whether there is a relationship between myocardial hyper-enhancement from remote scarring on DE-MRI and the degree of myocardial circumferential shortening (%CS) as determined with dynamic MRI tissue tagging (TAG-MRI) in the setting of chronic ischemic heart disease (CIHD).

Methods

Thirty-five patients with CIHD and 8 control patients underwent nonstress, resting DE-MRI and TAG-MRI. A total of 168 CIHD and 96 control segments from the basal- and middle-thirds of the left ventricle (LV) were selected to achieve a balanced test set. With a 16-segment model, segmental myocardial scarring was graded on the basis of the amount of hyper-enhancement on DE-MRI. With TAG-MRI images, segmental %CS was calculated.

Results

Patients with CIHD had lower LV ejection fraction compared with the control patients (28% vs 67%). The %CS of normal segments was notably different from %CS of CIHD segments, regardless of the presence or absence of myocardial hyper-enhancement on DE-MRI. Among the CIHD segments, however, %CS correlated inversely with the amount of myocardial hyper-enhancement from scarring (P <.0001, r = −0.38).

Conclusions

On cardiac MRI for CIHD, myocardial hyper-enhancement correlates inversely with %CS, supporting the direct relationship between the amount of remote myocardial scarring determined with nonstress DE-MRI and baseline resting functional impairment.     

Delayed enhancement magnetic resonance imaging predicts response to cardiac resynchronization therapy in patients with intraventricular dyssynchrony.

OBJECTIVES: We evaluated the ability of delayed enhancement magnetic resonance imaging (DE-MRI) to predict clinical response to cardiac resynchronization therapy (CRT). BACKGROUND: Cardiac resynchronization therapy reduces morbidity and mortality in selected heart failure patients. However, up to 30% of patients do not have a response. We hypothesized that scar burden on DE-MRI predicts response to CRT. METHODS: The DE-MRI was performed on 28 heart failure patients undergoing CRT. Patients with QRS > or =120 ms, left ventricular ejection fraction < or =35%, New York Heart Association functional class II to IV, and dyssynchrony > or =60 ms were studied. Baseline and 3-month clinical follow-up, wall motion, 6-min walk, and quality of life assessment were performed. The DE-MRI was performed 10 min after 0.20 mmol/kg intravenous gadolinium. Scar measured by planimetry was correlated with response criteria. RESULTS: Twenty-three patients completed the protocol (mean age 64.9 +/- 11.7 years), with 12 (52%) having a history of myocardial infarction. Thirteen (57%) patients met response criteria. Percent total scar was significantly higher in the nonresponse versus response group (median and interquartile range of 24.7% [18.1 to 48.7] vs. 1.0% [0.0 to 8.7], p = 0.0022) and predicted nonresponse by receiver-operating characteristic analysis (area = 0.94). At a cutoff value of 15%, percent total scar provided a sensitivity and specificity of 85% and 90%, respectively, for clinical response to CRT. Similarly, septal scar < or =40% provided a 100% sensitivity and specificity for response. Regression analysis showed linear correlations between percent total scar and change in each of the individual response criteria. CONCLUSIONS: The DE-MRI accurately predicted clinical response to CRT. This technique offers unique information in the assessment of patients referred for CRT.     

Magnetic resonance imaging and multi-detector computed tomography assessment of extracellular compartment in ischemic and non-ischemic myocardial pathologies

Myocardial pathologies are major causes of morbidity and mortality worldwide. Early detection of loss of cellular integrity and expansion in extracellular volume(ECV) in myocardium is critical to initiate effective treatment. The three compartments in healthy myocardium are: intravascular(approximately 10% of tissue volume), interstitium(approximately 15%) and intracellular(approximately 75%). Myocardial cells, fibroblasts and vascular endothelial/smooth muscle cells represent intracellular compartment and the main proteins in the interstitium are types Ⅰ/Ⅲ collagens. Microscopic studies have shown that expansion of ECV is an important feature of diffuse physiologic fibrosis(e.g., aging and obesity) and pathologic fibrosis [heart failure, aortic valve disease, hypertrophic cardiomyopathy, myocarditis, dilated cardiomyopathy, amyloidosis, congenital heart disease, aortic stenosis, restrictive cardiomyopathy(hypereosinophilic and idiopathic types), arrythmogenic right ventricular dysplasia and hypertension]. This review addresses recent advances in measuring of ECV in ischemic and non-ischemic myocardial pathologies. Magnetic resonance imaging(MRI) has the ability to characterize tissue proton relaxation times(T1, T2, and T2*). Proton relaxation times reflect the physical and chemical environments of water protons in myocardium. Delayed contrast enhanced-MRI(DE-MRI) and multi-detector computed tomography(DE-MDCT) demonstrated hyper-enhanced infarct, hypo-enhanced microvascular obstruction zone and moderately enhanced peri-infarct zone, but are limited for visualizing diffuse fibrosis and patchy microinfarct despite the increase in ECV. ECV can be measured on equilibrium contrast enhanced MRI/MDCT and MRI longitudinal relaxation time mapping. Equilibrium contrast enhanced MRI/MDCT and MRI T1 mapping is currently used, but at a lower scale, as an alternative to invasive sub-endomyocardial biopsies to eliminate the need for anesthesia, coronary catheterization and possibility of tissue sampling error. Similar to delayed contrast enhancement, equilibrium contrast enhanced MRI/MDCT and T1 mapping is completely noninvasive and may play a specialized role in diagnosis of subclinical and other myocardial pathologies. DE-MRI and when T1-mapping demonstrated sub-epicardium, sub-endocardial and patchy mid-myocardial enhancement in myocarditis, Behcet's disease and sarcoidosis, respectively. Furthermore, recent studies showed that the combined technique of cine, T2-weighted and DE-MRI technique has high diagnostic accuracy for detecting myocarditis. When the tomographic techniques are coupled with myocardial perfusion and left ventricular function they can provide valuable information on the progression of myocardial pathologies and effectiveness of new therapies.     

磁共振心肌灌注延迟增强与核素心肌灌注/代谢显像识别存活心肌对比研究

目的应用磁共振成像心肌灌注延迟显像(DE-MRI)所显示的高信号识别存活心肌和瘢痕组织,通过与99Tcm-甲氧基异丁基异腈(MIBI)单光子发射型计算机断层(SPECT)和18F-脱氧葡萄糖(FDG)SPECT进行对比研究,评估其诊断的敏感性和特异性,并分析两种方法的一致性。方法34例临床确诊的心肌梗死患者,拟行再血管化手术治疗。男性29例,女性5例,年龄(58.0±9.8)岁,接受心脏MRI及SPECT灌注/代谢显像检查。两种方法各划分5个等级,依据17节段分析法,分析34例患者共578个节段,并对两种评价心肌存活的方法行一致性分析。结果DE-MRI判断存活心肌431段(74.6%),坏死心肌147段(25.4%)。SPECT灌注/代谢显像诊断正常心肌336段(58.1%),坏死心肌212段(36.7%),缺血心肌30段(5.2%)。两种方法半定量分析显示一致性较好,Kappa值为0.51(>0.4)。以节段为单位,DE-MRI的敏感性为61.3%,特异性为95.4%。结论DE-MRI能够有效地识别存活心肌和瘢痕组织,并与18F-FDGSPECT一致性较好。     

Quantitative clinical assessment of chronic anterior myocardial infarction with delayed enhancement magnetic resonance imaging and QRS scoring

Background

Both the regional and global myocardial extent of chronic myocardial infarction (MI) are important prognostic factors for length and quality of life and also crucial for the choice of therapy in patients with ischemic heart disease. Our aim was to develop and validate techniques for comparison between regional and global size of remote anterior MI in the left ventricle quantified with both magnetic resonance imaging (MRI) and electrocardiogram (ECG).

Methods

Delayed-enhancement (DE) MRI was used as a clinical “gold standard” for MI size to evaluate the extent of MI estimated with the commonly available standard 12-lead ECG. A method for comparing global and regional quantifications of MI with DE-MRI and ECG was developed. The Selvester QRS-scoring system was used for estimating MI size electrocardiographically.

Results

Twenty-five patients with chronic single anterior MI, documented with DE-MRI, were studied. The best agreement for mean % MI per regional segment of the left ventricle was found in the middle third (26% vs 27%), whereas the most significant discrepancy was found in the apex (56% vs 30%). The global MI size of the left ventricle averaged 21 ± 9% with DE-MRI and 22% ± 12% with ECG, with a correlation of r = 0.40 (P <.05).

Conclusions

The current Selvester QRS scoring system performs well for quantifying anterior MI in the mid-regions of the left ventricle. The diagnostic performance of the Selvester QRS-scoring system for quantifying MI in the other regions, particularly the left ventricular apex, can potentially be improved, with DE-MRI as the gold standard.     

Comparison of Selvester QRS score with magnetic resonance imaging measured infarct size in patients with ST elevation myocardial infarction

Background and PurposeRecent studies have shown that the Selvester QRS score is significantly correlated with delayed enhancement-magnetic resonance imaging (DE-MRI) measured myocardial infarct (MI) size in reperfused ST elevation MI (STEMI). This study further tests the hypothesis that Selvester QRS score correlates well with MI size determined by DE-MRI in reperfused STEMI.Methods and ResultsThe relationship was evaluated retrospectively in 55 first-time STEMI patients 3 months after receiving primary percutaneous coronary intervention. Selvester QRS score and DE-MRI MI size were significantly correlated, r = 0.41 (P < .01). The difference between the Selvester QRS score and DE-MRI was 5.8% MI of the left ventricle (95% confidence interval, 2.9%-8.6%). Furthermore, increasing difference between Selvester QRS score and DE-MRI was observed with increasing MI size.ConclusionSelvester QRS score correlated only moderately with DE-MRI MI size. Selvester QRS score overestimated MI size.     

Cardiac Mr For The Assessment Of Myocardial Viability

This article focuses on delayed contrast enhanced MRI (DE-MRI) to assess myocardial viability. We start by discussing previous literature that evaluated the potential importance of myocardial viability testing and follow up with the more recent Surgical Treatment for Heart Disease Trial (STICH) trial results. We then provide an overview of the basic concepts and technical aspects of the current DE-MRI technique and review the initial studies demonstrating that DE-MRI before coronary revascularization can predict functional improvement. Finally, we use DE-MRI as a paradigm to discuss physiological insights into viability assessment and examine common assumptions in the metrics used to evaluate viability techniques.