This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wolfe, C. L. Articles by Brasch, R. C. Search for Related Content PubMed PubMed Citation Articles by Wolfe, C. L. Articles by Brasch, R. C.

Circulation, Vol 80, 969-982, Copyright © 1989 by American Heart Association

ARTICLES

Assessment of myocardial salvage after ischemia and reperfusion using magnetic resonance imaging and spectroscopy

CL Wolfe, ME Moseley, MG Wikstrom, RE Sievers, MF Wendland, JW Dupon, WE Finkbeiner, MJ Lipton, WW Parmley and RC Brasch
Department of Internal Medicine (Cardiology), University of California, San Francisco 94143-0124.

To test the hypothesis that contrast-enhanced magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) can differentiate reversible from irreversible myocardial injury, these modalities were used to study ischemia and reperfusion in a rat model. The presence of ischemia and reperfusion were confirmed with radiolabeled microspheres (n = 6). Groups of animals were subjected to either 16 (n = 17), 30 (n = 14), 60 (n = 11), or 90 (n = 14) minutes of left coronary artery (LCA) occlusion and 60 minutes reperfusion. After albumin-gadolinium (Gd)-DTPA injection, contrast-enhanced, T1-weighted, spin-echo proton images were acquired at baseline and every 16 minutes during LCA occlusion and reperfusion. In separate experiments, 31phosphorus (31P) spectra were acquired at similar time points during ischemia and reperfusion. After 16 minutes occlusion, normally perfused myocardium enhanced significantly compared with ischemic myocardium on MRI (104 +/- 7.9% vs. 61 +/- 11.0%, p less than 0.05, n = 5, mean +/- SEM, % of baseline value). MRS showed reduced phosphocreatine (PCr) and adenosine triphosphate (ATP) (58.8 +/- 2.4%, p less than or equal to 0.01; 81.4 +/- 2.4, p less than or equal to 0.01, n = 12). After 16 or 30 minutes ischemia, reflow resulted in uniform MRI signal intensity of the ischemic zone compared with normal myocardium (93.5 +/- 11.3 vs. 80.9 +/- 7.0, p = NS, n = 11, % of baseline value at 30 minutes reperfusion) and PCr recovery on MRS (94.3 +/- 4.0%, p = NS, n = 20, % baseline value at 30 minutes reflow). After 60 and 90 minutes ischemia, reflow resulted in marked enhancement of reperfused compared with normal myocardium on MRI (254.0 +/- 30.0 vs. 78.3 +/- 9.2, p less than or equal to 0.01, n = 10) and no recovery of PCr on MRS (64.1 +/- 3.0, p = NS, n = 14). Triphenyltetrazolium chloride (TTC) staining revealed transmural myocardial infarction (MI) in all hearts subjected to 60 or 90 minutes ischemia and reflow, and small nontransmural MIs in only 2/11 hearts subjected to 16 or 30 minutes ischemia and reperfusion. Thus, 1) MRI with albumin-Gd-DTPA is useful for identifying myocardial ischemia by enhancing the contrast between normally perfused and ischemic myocardia; 2) MRI with albumin-Gd-DTPA is useful for identifying reperfusion after myocardial ischemia; and 3) after reperfusion, reversible can be distinguished from irreversible myocardial injury by characteristic findings on MRI and MRS.

This article has been cited by other articles:

				M. Saeed, O. Weber, R. Lee, L. Do, A. Martin, D. Saloner, P. Ursell, P. Robert, C. Corot, and C. B. Higgins Discrimination of Myocardial Acute and Chronic (Scar) Infarctions on Delayed Contrast Enhanced Magnetic Resonance Imaging With Intravascular Magnetic Resonance Contrast Media J. Am. Coll. Cardiol., November 21, 2006; 48(10): 1961 - 1968. [Abstract] [Full Text] [PDF]

				S. J. Crozier, X. Zhang, J. Wang, J. Cheung, S. R. Kimball, and L. S. Jefferson Activation of signaling pathways and regulatory mechanisms of mRNA translation following myocardial ischemia-reperfusion J Appl Physiol, August 1, 2006; 101(2): 576 - 582. [Abstract] [Full Text] [PDF]

				K. L. Christman, A. J. Vardanian, Q. Fang, R. E. Sievers, H. H. Fok, and R. J. Lee Injectable fibrin scaffold improves cell transplant survival, reduces infarct expansion, and induces neovasculature formation in ischemic myocardium J. Am. Coll. Cardiol., August 4, 2004; 44(3): 654 - 660. [Abstract] [Full Text] [PDF]

				K. Ramani, R. M. Judd, T. A. Holly, T. B. Parrish, V. H. Rigolin, M. A. Parker, C. Callahan, S. W. Fitzgerald, R. O. Bonow, and F. J. Klocke Contrast Magnetic Resonance Imaging in the Assessment of Myocardial Viability in Patients With Stable Coronary Artery Disease and Left Ventricular Dysfunction Circulation, December 15, 1998; 98(24): 2687 - 2694. [Abstract] [Full Text] [PDF]

				J. Bremerich, M. F. Wendland, H.a. Arheden, R. Wyttenbach, D. W. Gao, J. P. Huberty, M. W. Dae, C. B. Higgins, and M. Saeed Microvascular injury in reperfused infarcted myocardium: noninvasive assessment with contrast-enhanced echoplanar magnetic resonance imaging J. Am. Coll. Cardiol., September 1, 1998; 32(3): 787 - 793. [Abstract] [Full Text] [PDF]

				R. J. Kim, E.-L. Chen, J. A.C. Lima, and R. M. Judd Myocardial Gd-DTPA Kinetics Determine MRI Contrast Enhancement and Reflect the Extent and Severity of Myocardial Injury After Acute Reperfused Infarction Circulation, December 15, 1996; 94(12): 3318 - 3326. [Abstract] [Full Text]

				T. Simor, W.-J. Chu, L. Johnson, A. Safranko, M. Doyle, G. M. Pohost, and G. A. Elgavish In Vivo MRI Visualization of Acute Myocardial Ischemia and Reperfusion in Ferrets by the Persistent Action of the Contrast Agent Gd(BME-DTTA) Circulation, December 15, 1995; 92(12): 3549 - 3559. [Abstract] [Full Text]

				E. E. van der Wall, H. W. Vliegen, A. de Roos, and A. V.G. Bruschke Magnetic Resonance Imaging in Coronary Artery Disease Circulation, November 1, 1995; 92(9): 2723 - 2739. [Abstract] [Full Text]

				R. M. Judd, C. H. Lugo-Olivieri, M. Arai, T. Kondo, P. Croisille, J. A.C. Lima, V. Mohan, L. C. Becker, and E. A. Zerhouni Physiological Basis of Myocardial Contrast Enhancement in Fast Magnetic Resonance Images of 2-Day-Old Reperfused Canine Infarcts Circulation, October 1, 1995; 92(7): 1902 - 1910. [Abstract] [Full Text]

				J. A. C. Lima, R. M. Judd, A. Bazille, S. P. Schulman, E. Atalar, and E. A. Zerhouni Regional Heterogeneity of Human Myocardial Infarcts Demonstrated by Contrast-Enhanced MRI : Potential Mechanisms Circulation, September 1, 1995; 92(5): 1117 - 1125. [Abstract] [Full Text]