PMID- 29680356 OWN - NLM STAT- MEDLINE DCOM- 20200113 LR - 20231011 IS - 1876-7591 (Electronic) IS - 1936-878X (Print) IS - 1876-7591 (Linking) VI - 12 IP - 4 DP - 2019 Apr TI - Influence of Myocardial Hemorrhage on Staging of Reperfused Myocardial Infarctions With T(2) Cardiac Magnetic Resonance Imaging: Insights Into the Dependence on Infarction Type With Ex Vivo Validation. PG - 693-703 LID - S1936-878X(18)30128-1 [pii] LID - 10.1016/j.jcmg.2018.01.018 [doi] AB - OBJECTIVES: This study sought to determine whether T(2) cardiac magnetic resonance (CMR) can stage both hemorrhagic and nonhemorrhagic myocardial infarctions (MIs). BACKGROUND: CMR-based staging of MI with or without contrast agents relies on the resolution of T(2) elevations in the chronic phase, but whether this approach can be used to stage both hemorrhagic and nonhemorrhagic MIs is unclear. METHODS: Hemorrhagic (n = 15) and nonhemorrhagic (n = 9) MIs were created in dogs. Multiparametric noncontrast mapping (T(1), T(2), and T(2)*) and late gadolinium enhancement (LGE) were performed at 1.5- and 3.0-T at 5 days (acute) and 8 weeks (chronic) post-MI. CMR relaxation values and LGE intensities of hemorrhagic, peri-hemorrhagic, nonhemorrhagic, and remote territories were measured. Histopathology was performed to elucidate CMR findings. RESULTS: T(2) of nonhemorrhagic MIs was significantly elevated in the acute phase relative to remote territories (1.5-T: 39.8 +/- 12.8%; 3.0-T: 27.9 +/- 16.5%; p < 0.0001 for both) but resolved to remote values by week 8 (1.5-T: -0.0 +/- 3.2%; p = 0.678; 3.0-T: -0.5 +/- 5.9%; p = 0.601). In hemorrhagic MI, T(2) of hemorrhage core was significantly elevated in the acute phase (1.5-T: 17.7 +/- 10.0%; 3.0-T: 8.6 +/- 8.2%; p < 0.0001 for both) but decreased below remote values by week 8 (1.5-T: -8.2 +/- 3.9%; 3.0-T: -5.6 +/- 6.0%; p < 0.0001 for both). In contrast, T(2) of the periphery of hemorrhage within the MI zone was significantly elevated in the acute phase relative to remote territories (1.5-T: 35.0 +/- 16.1%; 3.0-T: 24.2 +/- 10.4%; p < 0.0001 for both) and remained elevated at 8 weeks post-MI (1.5-T: 8.6 +/- 5.1%; 3.0-T: 6.0 +/- 3.3%; p < 0.0001 for both). The observed elevation of T(2) in the peri-hemorrhagic zone of MIs and the absence of T(2) elevation in nonhemorrhagic MIs were consistent with ongoing or absence of histological evidence of inflammation, respectively. CONCLUSIONS: Hemorrhagic MIs are associated with persisting myocardial inflammation and edema, which can confound staging of hemorrhagic MIs when T(2) elevations alone are used to discriminate between acute and chronic MI. Moreover, given the poor prognosis in patients with hemorrhagic MI, CMR evidence for myocardial hemorrhage with persistent edema may evolve as a risk marker in patients after acute MI. CI - Copyright (c) 2019 The Authors. Published by Elsevier Inc. All rights reserved. FAU - Wang, Guan AU - Wang G AD - Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China; Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California. FAU - Yang, Hsin-Jung AU - Yang HJ AD - Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California. FAU - Kali, Avinash AU - Kali A AD - Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California. FAU - Cokic, Ivan AU - Cokic I AD - Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California. FAU - Tang, Richard AU - Tang R AD - Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California. FAU - Xie, Guoxi AU - Xie G AD - Department of Biomedical Engineering, Guangzhou Medical University, Guangzhou, China. FAU - Yang, Qi AU - Yang Q AD - Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California. FAU - Francis, Joseph AU - Francis J AD - Department of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana. FAU - Li, Songbai AU - Li S AD - Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China. Electronic address: songbaili001@163.com. FAU - Dharmakumar, Rohan AU - Dharmakumar R AD - Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California; Department of Biomedical Engineering, Guangzhou Medical University, Guangzhou, China; David Geffen School of Medicine, University of California, Los Angeles, California. Electronic address: rohandkumar@csmc.edu. LA - eng GR - R01 HL133407/HL/NHLBI NIH HHS/United States GR - R01 HL136578/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20180418 PL - United States TA - JACC Cardiovasc Imaging JT - JACC. Cardiovascular imaging JID - 101467978 RN - 0 (Contrast Media) SB - IM CIN - JACC Cardiovasc Imaging. 2019 Apr;12(4):704-706. PMID: 30553675 MH - Animals MH - Contrast Media/administration & dosage MH - Disease Models, Animal MH - Dogs MH - Hemorrhage/*diagnostic imaging MH - *Magnetic Resonance Imaging MH - Myocardial Infarction/*diagnostic imaging/physiopathology/therapy MH - Myocardial Reperfusion MH - Predictive Value of Tests PMC - PMC6510271 MID - NIHMS1525953 OTO - NOTNLM OT - acute myocardial infarction OT - cardiac magnetic resonance OT - hemorrhage OT - inflammation OT - iron OT - preclinical study EDAT- 2018/04/24 06:00 MHDA- 2020/01/14 06:00 PMCR- 2019/05/10 CRDT- 2018/04/23 06:00 PHST- 2017/08/23 00:00 [received] PHST- 2018/01/17 00:00 [revised] PHST- 2018/01/18 00:00 [accepted] PHST- 2018/04/24 06:00 [pubmed] PHST- 2020/01/14 06:00 [medline] PHST- 2018/04/23 06:00 [entrez] PHST- 2019/05/10 00:00 [pmc-release] AID - S1936-878X(18)30128-1 [pii] AID - 10.1016/j.jcmg.2018.01.018 [doi] PST - ppublish SO - JACC Cardiovasc Imaging. 2019 Apr;12(4):693-703. doi: 10.1016/j.jcmg.2018.01.018. Epub 2018 Apr 18.