Why the study?
Does myocardial edema detected by T2-weighted CMR correlate with an increase in left ventricular end-diastolic wall thickness after brief ischemia and reperfusion?
Does myocardial edema detected by T2-weighted CMR correlate with an increase in left ventricular end-diastolic wall thickness after brief ischemia and reperfusion?
Myocardial edema detected by T2-weighted CMR after brief ischemia and reperfusion is associated with a small, clinically irrelevant increase in wall thickness, demonstrating that T2-weighted imaging is a more sensitive marker of acute injury.
Minimal EDWT rise despite T2 hyperintensity after reperfusion cautions against thickness-based edema assessment; leaves open human translation.
Purpose: We sought to assess the relationship between left ventricular regional end-diastolic myocardial wall thickness (EDWT) and myocardial edema defined using T2-weighted Cardiovascular Magnetic Resonance (CMR) after acute myocardial ischemia and reperfusion. Methods: T2-weighted and cine CMR images for 7 dogs at baseline, during coronary occlusion (mean 33 ± 4 minutes) and after reperfusion were studied. The EDWT was measured in segments with high signal intensity (SI) on T2-weighted images, adjacent segments and remote segments according to a 16-segment model. Results: The EDWT after reperfusion in segments with high SI on T2-weighted images was significantly increased compared to baseline (6.28 ± 1.06 mm and 5.51 ± 1.40 mm, p < 0.05), whereas EDWT after the reperfusion in adjacent and remote segments did not show significant difference compared to baseline (adjacent: 6.48 ± 1.55 mm and 6.38 ± 1.26 mm, p = N.S., remote: 6.41 ± 1.11mm and 6.42 ± 1.27mm, p = N.S.). The % increase in EDWT after reperfusion from baseline in segments with high SI on T2-weighted images was higher than those in adjacent and remote segments (19 ± 30%, 1.3 ± 15% and 1.5 ± 16%, respectively, p < 0.05). Conclusions: After a brief period of ischemia and reperfusion, edema as defined by high SI on T2-weighted CMR is related to an increase in EDWT. This increase however is too small to be clinically relevant to be used for the detection of acute myocardial injury. Edema imaging is more sensitive and is an essential part of the reliable assessment of acute ischemic myocardial injury.
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Mikami et al. (2014) studied this question.
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