Diagnostic accuracy of 3.0-T magnetic resonance T1 and T2 mapping and T2-weighted dark-blood imaging for the infarct-related coronary artery in Non-ST-segment elevation myocardial infarction

Jamie Layland, Samuli Rauhalammi, Matthew M.Y. Lee, Nadeem Ahmed, Jaclyn Carberry, Vannesa Teng Yue May, Stuart Watkins, Christie McComb, Kenneth Mangion, John D. McClure, David Carrick, Anna O'Donnell, Arvind Sood, Margaret McEntegart, Keith G. Oldroyd, Aleksandra Radjenovic, Colin Berry

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Abstract

Background--Patients with recent non-ST-segment elevation myocardial infarction commonly have heterogeneous characteristics that may be challenging to assess clinically. Methods and Results--We prospectively studied the diagnostic accuracy of 2 novel (T1, T2 mapping) and 1 established (T2-weighted short tau inversion recovery [T2W-STIR]) magnetic resonance imaging methods for imaging the ischemic area at risk and myocardial salvage in 73 patients with non-ST-segment elevation myocardial infarction (mean age 57±10 years, 78% male) at 3.0-T magnetic resonance imaging within 6.5±3.5 days of invasive management. The infarct-related territory was identified independently using a combination of angiographic, ECG, and clinical findings. The presence and extent of infarction was assessed with late gadolinium enhancement imaging (gadobutrol, 0.1 mmol/kg). The extent of acutely injured myocardium was independently assessed with native T1, T2, and T2W-STIR methods. The mean infarct size was 5.9±8.0% of left ventricular mass. The infarct zone T1 and T2 times were 1323±68 and 575 ms, respectively. The diagnostic accuracies of T1 and T2 mapping for identification of the infarct-related artery were similar (P=0.125), and both were superior to T2W-STIR (P < 0.001). The extent of myocardial injury (percentage of left ventricular volume) estimated with T1 (15.8±10.6%) and T2 maps (16.0±11.8%) was similar (P=0.838) and moderately well correlated (r=0.82, P < 0.001). Mean extent of acute injury estimated with T2W-STIR (7.8±11.6%) was lower than that estimated with T1 (P < 0.001) or T2 maps (P < 0.001). Conclusions--In patients with non-ST-segment elevation myocardial infarction, T1 and T2 magnetic resonance imaging mapping have higher diagnostic performance than T2W-STIR for identifying the infarct-related artery. Compared with conventional STIR, T1 and T2 maps have superior value to inform diagnosis and revascularization planning in non-ST-segment elevation myocardial infarction.

Original languageEnglish
Article numbere004759
Number of pages12
JournalJournal of the American Heart Association
Volume6
Issue number4
DOIs
Publication statusPublished - Apr 2017
Externally publishedYes

Keywords

  • Acute coronary syndrome
  • Area at risk
  • Edema
  • Mapping
  • Non-ST-segment elevation acute coronary syndrome
  • Noninvasive imaging

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