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(Circulation. 1999;99:284-291.)
© 1999 American Heart Association, Inc.

Basic Science Reports

Differentiation of Viable and Nonviable Myocardium by the Use of Three-Dimensional Tagged MRI in 2-Day-Old Reperfused Canine Infarcts

Presented in part at the 68th Scientific Sessions of the American Heart Association, Anaheim, Calif, November 13–16, 1995, and previously published in abstract form (Circulation. 1995;92:I-508).

P. Croisille, MD; C. C. Moore, MD, PhD; R. M. Judd, PhD; J. A. C. Lima, MD; M. Arai, MD; E. R. McVeigh, PhD; L. C. Becker, MD; E. A. Zerhouni, MD

From the Departments of Radiology and Medicine (P.C., R.M.J., J.A.C.L., M.A., L.C.B., E.A.Z.) and the Department of Biomedical Engineering (C.C.M., E.R.M.), Johns Hopkins University, School of Medicine, Baltimore, Md; and the Departement de Radiologie (P.C.), Hôpital Cardiologique et Pneumologique L. Pradel, Lyon, France.

Correspondence to Pierre Croisille, MD, Departement de Radiologie, Hôpital Cardiologique et Pneumologique, L. Pradel 59 Bd Pinel, BP Lyon Montchat F-69394, Lyon, Cedex 03, France. Email croisille{at}creatis.univ-lyon1.fr.

Background—To limit ischemic myocardial injury, it is important to differentiate viable from infarcted myocardium. Three dimensional (3D) tagged MRI has the ability to quantify myocardial 3D deformation and strain (noninvasively and precisely), and can achieve a true comparison of contraction not only from region to region, but also at different levels of function. In this study, we investigated whether regional strain mapping obtained by 3D-tagged MRI can differentiate between viable but stunned myocardium and nonviable myocardium.

Methods and Results—We examined 7 dogs 2 days after a 90-minute closed-chest left anterior descending coronary artery occlusion followed by 48 hours of reperfusion. 3D-tagged MR images spanning the entire left ventricle were acquired both at rest and during dobutamine infusion (5 µg · kg^-1 · min^-1 IV). Regional blood flow was measured with radioactive microspheres and used to define risk regions. Infarcted regions were defined as 2,3,5 triphenyltetrazolium chloride negative regions. Strains in infarcted regions were greatly impaired compared with remote regions (P<0.001) and remained unchanged during dobutamine stress. Risk regions showed a dysfunction at rest, with improved function during dobutamine infusion. Receiver operating characteristics analysis showed that radial strain was more accurate for identifying viable regions.

Conclusions—When coupled with a stress test, 3D strain mapping by the use of tagged MRI is a sensitive and noninvasive method for characterizing ischemic injury. Regional strain can be used to differentiate between viable but stunned and nonviable myocardium within the postischemic injured myocardium.

Key Words: myocardial contraction • stunning, myocardial • inotropic agents • ischemia • magnetic resonance imaging

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