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European Heart Journal 2006 27(15):1766; doi:10.1093/eurheartj/ehi711
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

In vivo demonstration of lipomatous metaplasia in left ventricular scar following myocardial infarction

Jordi Estornell1,*, Raquel Jimenez2 and Francisco Ridocci3

1 CT and CMR Unit, ERESA
2 Pathology Department
3 Cardiology Department, Consorcio Hospital General Universitario de Valencia, Av. Tres Cruces 2, 46014 Valencia, Spain

* Corresponding author. Tel: +34 961972000; fax: +34 961972161. E-mail address: jestornell{at}eresa.com

A 65-year-old man with history of anterior myocardial infarction 6 years before was admitted for congestive heart failure. Echocardiography revealed a markedly dilated left ventricle with severe systolic dysfunction (EF 32%), apical aneurysm, and diffuse hypokinesis of the other segments. Cardiac catheterization showed three-vessel disease. Gadolinium-enhanced cardiac magnetic resonance (CMR) was performed to assess myocardial viability. Functional CMR with steady-state free precession imaging confirmed echocardiographic findings. Abnormal intramural lineal hyperintense area was detected in thinned anteroseptal mid-ventricular and apical segments. T1-weightened turbo spin-echo sequence also showed intramural lineal hyperintense area in the same segments suggesting myocardial fatty replacement (Panel A) that was confirmed with a fat suppression pulse (Panel B). Transmural gadolinium-enhanced CMR demonstrated non-viable myocardium in the anteroseptal and apical segments and patient underwent surgical coronary revascularization with left ventricular aneurysmectomy (Dor procedure). Histological analysis of specimen revealed fatty metaplasia of scar (Panels C and D) that confirmed CMR findings.

Panel (A) Anatomic CMR sequence showing intramural lineal hyperintense area in anteroseptal mid-ventricular and apical segments (arrow). (B) T1-weightened turbo-spin echo with fat suppression that nulls intramural hyperintense area. (C) Histologic specimen from aneurysmectomy (haematoxylin-eosin). (D) (200x). e, endocardium; f, fibrosis; m, myocites; F, fatty tissue.

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