| Coronary Heart Disease | published September 16., 2002 |
| Large anterior myocardinal infarction in a 22 year old subject with depressed LV function - viability study | 22 year old male smoker and extensive anterior myocardial infarction 11/2001 underwent rescue PTCA at the University Hospital of Basel. LV function was depressed (LVEF 33%, LVEDV 300 ml) and there was suspicion for an apical thrombus by echocardiography, later confirmed by CMR. The delayed imaging shows a large anterior myocardial infarction with transmurality in the mid and distal anterior LV portion, as well as in the apex and the middle and distal anterior septum. |
| Comment: CMR has a high
capability to detect even small myocardial infarctions with higher accuracy
than myocardial perfusion SPECT or PET. The degree of transmurality is a
direct marker of viability and does not require potentially arrhythmogenic
dobutamin stimulations. A scar transmurality of > 75% is usually associated
with failure of function recovery in the future. In subjects tolerating the
magnetic bore, and not having contraindications to magnetic resonance
imaging, CMR should be the first choice to define viability in humans.
The article by Dr Lima in a recent Circulation publication (see below) shows a first generation image resolution. Comparing his images with the new Philips delayed imaging sequences shows, that it is likely that higher image resolution will result in higher accuracy (> 80%, possibly 90%) to predict regions with functional recovery and thus viability. An other very important field of research is the question of revascularization of extensive myocardial scars, e.g. after anterior myocardial infarction. It could well be, that even small subepicardial layers of viable tissue might increase survival, if blood flow is unhampered. |
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| The images to the right show a large anteroseptal myocardial infarction with large zones of transmurality. The Cine shows a 2CH view with an apical thrombus. |
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