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European Heart Journal 2004 25(23):2172; doi:10.1016/j.ehj.2004.08.027
Copyright © 2004 by the European Society of Cardiology.
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Letter to the Editor

Myocardial infarction after coronary revascularization: role of cardiovascular magnetic resonance oedema imaging

Hassan Abdel-Atya,*, Matthias G. Friedrichb and Jeanette Schulz-Mengera

a Franz-Volhard-Klinik, Helios-Klinikum Berlin, Kardiologie, Charité Campus Berlin-Buch, Humboldt-Universität zu Berlin, Wiltbergstr. 50, D-13125, Berlin, Germany
b Department of Cardiac Sciences, University of Calgary, Foothills Hospital, Calgary, Canada

* Tel.: +49 30 9417 2282; fax: +49 30 9417 2560 (E-mail: abdel-aty{at}fvk.charite-buch.de).

We read with interest the article by Steuer et al., recently published in the Journal.1 The authors attempted to visualize and quantify the amount of irreversible myocardial injury related to the coronary artery bypass procedure using delayed enhancement cardiovascular magnetic resonance (CMR). As suggested by the authors and the related editorial in the Journal,2 the clinical utilization of this approach would be confounded by the inability of delayed enhancement to differentiate acute, newly developing infarcts from chronic myocardial scars.

We have recently described an imaging approach that can be of great help in this setting.3 Combining delayed enhancement with corresponding T2-weighted CMR enabled us to differentiate acute from chronic myocardial infarction with 96% specificity. The approach relies on the ability of T2-weighted sequences to accurately identify myocardial oedema, a feature of acute but not of chronic myocardial infarcts. Accordingly, acute infarcts consistently exhibit transmural high T2 signal intensity together with delayed enhancement. We believe that this imaging approach could thus obviate the need to double-scan the patients (before and after coronary revascularization) and would overcome the known limitations of ECG, echocardiography and radionuclide imaging in this clinical setting.

References

  1. Steuer J, Bjerner T, Duvernoy O, et al. Visualisation and quantification of peri-operative myocardial infarction after coronary artery bypass surgery with contrast-enhanced magnetic resonance imaging Eur Heart J 2004;25:1293-1299.[Abstract/Free Full Text]
  2. Schoenhagen P. The emerging role of delayed contrast-enhanced magnetic resonance imaging in the peri-operative evaluation of patients undergoing coronary revascularisation Eur Heart J 2004;25:1279-1280.[Free Full Text]
  3. Abdel-Aty H, Zagrosek A, Schulz-Menger J, et al. Delayed enhancement and T2-weighted cardiovascular magnetic resonance imaging differentiate acute from chronic myocardial infarction Circulation 2004;109:2411-2416.[Abstract/Free Full Text]

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