Contrast magnetic resonance imaging in the assessment of myocardial viability in patients with stable coronary artery disease and left ventricular dysfunction.

K Ramani, R M Judd, T A Holly, T B Parrish, V H Rigolin, M A Parker, C Callahan, S W Fitzgerald, R O Bonow, F J Klocke

Departments of Medicine, Radiology, and Biomedical Engineering and the Feinberg Cardiovascular Research Institute, Northwestern University Medical School, Chicago, IL, USA.

Circulation 1998 Dec 15

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The utility of contrast MRI for assessing myocardial viability in stable coronary artery disease (CAD) with left ventricular dysfunction is uncertain. We therefore performed cine and contrast MRI in 24 stable patients with CAD and regional contractile abnormalities and compared MRI findings with rest-redistribution 201Tl imaging and dobutamine echocardiography. Delayed MRI contrast enhancement patterns were examined from 3 to 15 minutes after injection of 0.1 mmol/kg IV gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA). Comparable MRI and 201Tl basal and midventricular short-axis images were subdivided into 6 segments. Segments judged nonviable by quantitative and qualitative assessment of 201Tl scans showed persistent, systematically greater MRI contrast signal intensity than segments judged viable (Pdobutamine echocardiography (Phypokinesis, 58% of segments showing hyperenhancement were judged viable by 201Tl and may have represented an admixture of scar tissue and viable myocardium. Delayed (by 3 to 15 minutes) hyperenhancement of Gd-DTPA contrast-enhanced MRI images occurs frequently in dysfunctional areas of the left ventricle in patients with stable CAD. Hyperenhancement is associated with nonviability by rest-redistribution 201Tl scintigraphy and dobutamine echocardiography, particularly in regions exhibiting resting akinesis/dyskinesis. The absence of hyperenhancement correlates with radionuclide and echocardiographic determinations of viability, regardless of resting contractile function.

Citation

K Ramani, R M Judd, T A Holly, T B Parrish, V H Rigolin, M A Parker, C Callahan, S W Fitzgerald, R O Bonow, F J Klocke. Contrast magnetic resonance imaging in the assessment of myocardial viability in patients with stable coronary artery disease and left ventricular dysfunction. Circulation. 1998 Dec 15;98(24):2687-94