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124 Delayed-enhancement MRI as a predictor of functional recovery after revascularization: results from an International Multicenter Viability Trial

  • Veronica V Lenge
  • Raja Muthupillai
  • Harrie Van den Bosch
  • John Greenwood
  • Rungroj Krittyaphong
  • Wong Yong Kim
  • Reza Razavi
  • Peter Danias
  • Eike Nagel
  • Scott D Flamm
Open Access
Meeting abstract

Keywords

Wall Motion Abnormality Chronic Coronary Artery Disease Dysfunctional Segment Standardize Imaging Protocol Segmental Wall Motion Abnormality 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Purpose

Several single center studies have shown that Delayed-enhancement (MRI DE-MRI) can predict functional recovery after revascularization [1, 2]. The purpose of this study was to determine the prognostic value of DE-MRI for predicting recovery of regional wall motion abnormality after revascularization in patients with chronic coronary artery disease (CAD) in a prospective, international, multi-center trial.

Methods

183 patients (167 men, age: 59.1 ± 9.7 years) with angiographically confirmed CAD and resting wall motion abnormality (WMA) scheduled for coronary bypass (n = 101) or angioplasty (n = 82) were enrolled from 9 institutions (US, Europe, and Asia) using a standardized imaging protocol. Functional and DE-MRI were performed within 30 days prior to and 5.6 ± 2.4 months after intervention.

Data Acquisition

All images were acquired on a Philips 1.5 T imager with VCG gating, and a five-element synergy cardiac coil was used for signal reception. A steady-state free precession (SSFP) sequence was used for cardiac cine imaging: TR/TE/flip: 2.7 msec/1.3 msec/65°; FOV: 320 mm, matrix: 160 × 160, slice thickness: 10 mm; slice gap: 0 mm; acquired voxel size: 2.0 × 2.0 × 10.0 mm and reconstructed voxel size: 1.3 × 1.3 × 10.0 mm; temporal resolution: 25–40 msec depending on heart rate. Cine SSFP images were acquired in the two long – axis orientations (vertical long axis and 4 chambers) and short axis orientations (10 to 12 contiguous short-axis cine SSFP images from mitral valve plane through the apex). DE-MRI images were acquired 15 minutes after administering 0.2 mmol/kg of gadolinium-chelate (OptiMARK™) in the same orientation as the cine images. The DE-MRI sequence was an inversion-recovery prepared, segmented gradient echo acquisition with the following acquisition parameters: field-of-view: 384 × 384 mm; matrix size: 256 × 256; acquired voxel size: 1.5 × 1.5 × 10 mm; 32 phase encoding steps per RR interval; TR/TE/flip: 4.6/1.9/15°; NSA: 2; acquisition time per slice: 16 RR intervals. The inversion delay time (TI) between the inversion pulse and the beginning of the data acquisition necessary to null the signal from normal myocardium was determined by the Look-Locker sequence. The data acquisition was timed to occur in diastole to minimize cardiac motion.

Data Analysis

Cine and delayed – enhanced images were analyzed based on the model proposed by Kim R et al [1] in which the left ventricle was divided into 12 equiangular segments on 8 – 10 short – axis views, depending on the length of ventricle. Progressively worsening segmental WMA and increasing extent of DE were scored on a scale of 0 – 4 [1].

Results

At baseline, 5580/12274 (46%) segments had abnormal contractility, and 2974/12274 (24%) segments had DE. Improvement in contractility of impaired segments following revascularization correlated inversely with the transmural extent of scar (r2 = 0.9, Fig. 1). For instance, 72% of dysfunctional segments without evidence of scar at baseline showed improvement in contractility following revascularization, and remarkably, 52% of such segments had complete recovery of function (p < 0.001). Conversely, less than a fourth (250/1438, 17%) of the segments with near or complete transmural scar (score 3 and 4) had any functional recovery (P value < 0.001).
Figure 1

The Multicenter Viability Trial confirmed the prognostic value of DE-MRI for predicting recovery of left ventricular function recovery after revascularization in patients with chronic coronary artery disease (CAD).

Conclusion

The results from the first, global, multi-center trial determined that DE-MRI is a robust predictor of functional recovery after revascularization.

References

  1. 1.
    Kim RJ, et al: The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. N Engl J Med. 2000, 343: 1445-53. 10.1056/NEJM200011163432003.CrossRefPubMedGoogle Scholar
  2. 2.
    Selvanayagam JB, et al: Value of delayed-enhancement cardiovascular magnetic resonance imaging in predicting myocardial viability after surgical revascularization. Circulation. 2004, 110: 1535-41. 10.1161/01.CIR.0000142045.22628.74.CrossRefPubMedGoogle Scholar

Copyright information

© Lenge et al; licensee BioMed Central Ltd. 2008

This article is published under license to BioMed Central Ltd.

Authors and Affiliations

  • Veronica V Lenge
    • 1
  • Raja Muthupillai
    • 2
  • Harrie Van den Bosch
    • 3
  • John Greenwood
    • 4
  • Rungroj Krittyaphong
    • 5
  • Wong Yong Kim
    • 6
  • Reza Razavi
    • 7
  • Peter Danias
    • 8
  • Eike Nagel
    • 9
  • Scott D Flamm
    • 10
  1. 1.Baylor College of MedicineHoustonUSA
  2. 2.St Luke's Episcopal Hospital – THIHoustonUSA
  3. 3.Catharina Ziekenhuis HospitalEindhovenThe Netherlands
  4. 4.Leeds General InfirmaryLeedsUK
  5. 5.Siriraj HospitalBangkokThailand
  6. 6.Skejby University HospitalAarhusDenmark
  7. 7.Guy's HospitalLondonUK
  8. 8.Hygeia HospitalMaroussiGreece
  9. 9.German Heart Institute BerlinBerlinGermany
  10. 10.Cleveland Clinic FoundationClevelandUSA

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