Serial Contrast-Enhanced Cardiac Magnetic Resonance Imaging Demonstrates Regression of Hyperenhancement Within the Coronary Artery Wall in Patients After Acute Myocardial Infarction

• Published in: JACC. Cardiovascular imaging 2009-05, Vol.2 (5), p.580-588
• Main Authors: Ibrahim, Tareq, MD, Makowski, Markus R., MD, Jankauskas, Antanas, MD, Maintz, David, MD, Karch, Martin, MD, Schachoff, Sylvia, RT, Manning, Warren J., MD, Schömig, Albert, MD, Schwaiger, Markus, MD, Botnar, Rene M., PhD
• Format: Article
• Language: English
• Subjects: Aged; Angioplasty, Balloon, Coronary - instrumentation; C-Reactive Protein - metabolism; Cardiovascular; Case-Control Studies; Contrast Media; Coronary Angiography; Coronary Stenosis - complications; Coronary Stenosis - immunology; Coronary Stenosis - pathology; Coronary Stenosis - therapy; Coronary Vessels - immunology; Coronary Vessels - pathology; Drug-Eluting Stents; Female; Gadolinium DTPA; Humans; Inflammation - complications; Inflammation - immunology; Inflammation - pathology; Inflammation Mediators - metabolism; Magnetic Resonance Angiography; Male; Middle Aged; Myocardial Infarction - etiology; Myocardial Infarction - immunology; Myocardial Infarction - pathology; Myocardial Infarction - therapy; Predictive Value of Tests; Prospective Studies; Time Factors; Treatment Outcome
• ISSN: 1936-878X; 1876-7591
• DOI: 10.1016/j.jcmg.2008.12.029

Objectives Our aim was to determine whether serial contrast-enhanced cardiac magnetic resonance (CE-CMR) is useful for the characterization of tissue signal changes within the coronary vessel wall in patients after acute myocardial infarction (AMI). Background Inflammation plays a key role in the development of AMI. CE-CMR of the vessel wall has been found useful for the characterization of inflammatory tissue signal changes in patients with carotid artery stenosis, giant cell arteritis, or Takayasu's arteritis; however, it has never been serially performed in the coronary artery wall in patients with acute and chronic myocardial infarction using a gadolinium-based contrast medium and compared with systemic markers of inflammation. Methods CE-CMR using a T1-weighted 3-dimensional gradient echo inversion recovery sequence of the coronary artery wall and 0.2 mmol/kg of gadolinium-diethylenetriaminepentaacetic acid was performed in 10 patients with AMI 6 days and 3 months after coronary intervention and in 9 subjects without coronary artery disease on invasive coronary angiography. Contrast-to-noise ratio (CNR) within the coronary artery wall was quantified in comparison with blood signal. Results Patients with AMI demonstrated a significantly increased coronary vessel wall enhancement 6 days after infarction compared with normal subjects (CNR 7.8 ± 4.4 vs. 5.3 ± 3.2, p < 0.001). Three months after infarction, CNR decreased to 6.5 ± 4.7 (p < 0.03). This decrease paralleled declines in C-reactive protein. Angiographically normal segments showed no contrast changes, but CNR significantly decreased in stenotic segments, from 10.9 ± 3.8 to 6.8 ± 5.0 (p < 0.002), resulting in a reduction of enhanced segments from 70% to 25% (p < 0.01). Conclusions Serial CE-CMR identified changes in spatial extent and intensity of coronary contrast enhancement in patients after AMI. This technique may be useful for the characterization of transient coronary tissue signal changes, which may represent edema or inflammation during the post-infarction phase. In addition, CE-CMR may offer the potential for visualization of inflammatory activity in atherosclerosis associated with acute coronary syndromes.