Assessing myocardial viability and infarct transmurality with left ventricular electromechanical mapping in patients with stable coronary artery disease: validation by delayed-enhancement magnetic resonance imaging.

Abstract:

BACKGROUND:This study was designed to define myocardial viability and establish practical cut-off values for differentiating normal myocardial tissue from subendocardial and transmural scar tissue by using electromechanical mapping (EMM). We validated our results by delayed-enhancement cardiac MRI (DE-MRI). METHODS AND RESULTS:We prospectively studied 15 ambulatory patients with stable coronary disease who were candidates for cardiac catheterization. Within 48 hours of EMM, DE-MRI was performed. Using EMM software, we created a bull's eye precisely matched to that generated by DE-MRI. Segment by segment, we compared the MRI results to the corresponding unipolar voltage value for that same segment in the EMM bull's eye. Of 300 total segments, 275 were compared. The segments were divided into normal (n=211), subendocardial scar (n=49), and transmural scar (n=15). We found that subendocardial (6.8+/-2.9 mV) and transmural (4.6+/-1.9 mV) scar segments had significantly less unipolar voltage than normal (11.6+/-4.5 mV) segments (P<0.05 for each comparison). When normal myocardium was compared with myocardium with subendocardial scar, the threshold for differentiating between the two areas was 7.9 mV (sensitivity, 80%; specificity, 80%). Comparison of normal tissue to transmural scar yielded a threshold of 6.9 mV (sensitivity, 93%; specificity, 88%). CONCLUSIONS:Our results demonstrate that normal myocardium can be accurately distinguished from myocardium with subendocardial or transmural infarcts on the basis of unipolar voltage values obtained through EMM. This is the first study to validate these results by using cardiac DE-MRI in humans.

journal_name

Circulation

journal_title

Circulation

authors

Perin EC,Silva GV,Sarmento-Leite R,Sousa AL,Howell M,Muthupillai R,Lambert B,Vaughn WK,Flamm SD

doi

10.1161/01.cir.0000026394.01888.18

subject

Has Abstract

pub_date

2002-08-20 00:00:00

pages

957-61

issue

8

eissn

0009-7322

issn

1524-4539

journal_volume

106

pub_type

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