Early assessment of myocardial salvage by contrast-enhanced magnetic resonance imaging

Background-Myocardial salvage after acute myocardial infarction is defined clinically by early restoration of flow and long-term improvement in contra ctile function. We hypothesized that contrast-enhanced magnetic resonance i maging (MRI), performed early after myocardial infarction, indexes myocardi al salvage. We studied the relationship between the transmural extent of hy perenhancement by contrast-enhanced MRI, restoration of flow, and recovery of function. Methods and Results-The left anterior descending coronary artery was occlud ed in dogs (n=15) for either 45 minutes, 90 minutes, or permanently. Cine a nd contrast-enhanced MRI were performed 3 days after the procedure; cine MR I was also done 10 and 28 days after the procedure. The transmural extent o f hyperenhancement and wail thickening were determined using a 60-segment m odel. The mean transmural extent of hyperenhancement for the 45-minute occl usion group was 22% of the 90-minute group and 18% of the permanent occlusi on group (P<0.05 for both). The transmural extent of hyperenhancement on da y 3 was related to future improvement in both wall thickening score and abs olute wall thickening at 10 and 28 days (P<0.0001 for each). For example, o f the 415 segments on day 3 that were dysfunctional and had <25% transmural hyperenhancement, 362. (87%) improved by day 28. Conversely, no segments ( 0 of 9) with 100% hyperenhancement improved. The transmural extent of hyper enhancement on day 3 was a better predictor of improvement in contractile f unction than occlusion time (P<0.0001). Conclusions-A reduction in the transmural extent of hyperenhancement by con trast-enhanced MRI early after myocardial infarction is associated with an early restoration of flow and future improvement in contractile function.