Ośrodek Diagnostyki i Rehabilitacji Chorób Serca i Płuc

1. MRI and Biomarkers in Acute Myocardial Infraction Ośrodek Diagnostyki i Rehabilitacji Chorób Serca i Płuc Krakowski Szpital Specjalistyczny im. Jana Pawła II Klimeczek P., Zalewski J., Banys R., Pasowicz M., Żmudka K.

2. 50 20 10 5 2 1 0 0 1 2 3 4 5 6 7 8 Biomarkers in ACS A– early CK-MB B – cardiac troponinC – CK-MB D –cardiac troponin after UA B C Value A Highest level of reference Cut off point for AMI D Days after ACS episode Wu AH, et al. Clin Chem 1999;45:1104

3. Ideal biomarker • High specificity and sensivity • Early onset in plasma • High concentration in plasma during first few days of AMI • Sensitivity for detection of coronary reperfusion • Fast, easy, not expensive test

4. 13 minutes TROPONINE I MIOGLOBIN CK-MB mass

5. Visualisation of AMI • X-ray angio : coronary arteries and ventriculogaphy • ECHO • Contrast ECHO • Scintygraphy • MRI

8. MRI in AMI • Function : EF, EDV,ESV, CO, SV • LV mass • Contractility (global and segmental) • Wall thickness • Wall thickening • Perfusion • Viability

9. CMR has been used in emergency room to asses chesta pain Kwong RY, Schussheim AE, Rekhraj S et al. Detecting acute coronary syndrome in the emergency department with cardiacmagnetic resonance imaging. Circulation 2003;107:531–7. CMR showed a sensitivity and specificity of 84% and 85% for identifying patients with CAD, and multi-variate analysis including standard clinical tests (ECG, troponin, TIMI risk score) showed that CMR was the strongest predictor of CAD and added diagnostic value over clinical parameters, including identification of enzyme-negative unstable angina. This promising data needs to be confirmed in other centres.

10. CMR identifies microvascular obstruction in acute • MI early (1–2 min) after intravenous injection of gadolinium. • Gerber BL, Rochitte CE, Melin JA et al. Microvascular obstruction • and left ventricular remodeling early after acute myocardial • infarction. Circulation 2000;101:2734–41. • Microvascular obstruction detected by CMR has • been linked to ventricular remodeling • Wu KC, Zerhouni EA, Judd RM et al. Prognostic significance of • microvascular obstruction by magnetic resonance imaging in • patients with acute myocardial infarction. Circulation • 1998;97:765–72. • The transmural extent of late gadolinium-enhancement CMR predicts recovery of function following acute MI. • Choi KM, Kim RJ, Gubernikoff G et al. Transmural extent of acute • myocardial infarction predicts long-term improvement in contractile • function. Circulation 2001;104:1101–7.

11. Higgins et al. 2003

12. Area at risc – STIRoedema sensitive imaging (without contrast) AMI AMI myocarditis

13. Viability study/ microvascular obstruction visualisation Anterior wall infraction, different inversion times

14. Material

15. MRI examination (1.5 T) at third day and 30 days after ACS • Scouts • Cine - SSFP 4 chamber, 2 chamber • Flip angle - , TR, TE • The stack of cine-SSFP covering LV (slice 10 mm, gap – 0) • Contrast injection 0.15 mg/kg 3, 5, 10, 12 min after contrast injection LE scout (inversion time assessment) short axis SSFP – single shot (6 – 8 slices, slice 10 mm, gap 50%), flip angle 30 deg,

16. 1.5 T MRI – 72 hours after PCI Volume (ESV, EDV, EF, CO) Contractility (17 segments,normokinesia hipokinesia, akinesia, dyskinesia) LV diameters ( measurments in basal segments) LV wall diameters ( measurments in basal segments) DE quantification Method

17. Results for third day The mean mass of enhanced myocardium was 41 SD 26 g. Tab 1. Correlation between CPK-MB value and the mass of contrast enhanced myocardium

18. Results for 30 days The mean mass of enhanced myocardium was 20 SD 15 g. Tab 1. Correlation between CPK-MB value and the mass of contrast enhanced myocardium

22. Work in progress • Influence of scar mass or scar volume on post – AMI complexed arrhytmia risk • Correlation between burden damaged myocardium and remodeling indicators: • EDV • ESV • Segmental thickenig and thickness