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Coronary artery disease
Original research article
Impact of microvascular obstruction on semiautomated techniques for quantifying acute and chronic myocardial infarction by cardiovascular magnetic resonance
  1. Heerajnarain Bulluck1,2,3,4,
  2. Stefania Rosmini5,
  3. Amna Abdel-Gadir5,
  4. Anish N Bhuva5,
  5. Thomas A Treibel5,
  6. Marianna Fontana2,6,
  7. Shane Weinmann1,
  8. Alex Sirker2,5,
  9. Anna S Herrey5,
  10. Charlotte Manisty2,5,
  11. James C Moon2,5 and
  12. Derek J Hausenloy1,2,3,4
  1. 1The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, London, UK
  2. 2The National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, UK
  3. 3Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore, Singapore
  4. 4National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
  5. 5Barts Heart Centre, St Bartholomew's Hospital, London, UK
  6. 6National Amyloidosis Centre, University College London, Royal Free Hospital, London, UK
  1. Correspondence to Dr Heerajnarain Bulluck; h.bulluck{at}gmail.com

Abstract

Aims The four most promising semiautomated techniques (5-SD, 6-SD, Otsu and the full width half maximum (FWHM)) were compared in paired acute and follow-up cardiovascular magnetic resonance (CMR), taking into account the impact of microvascular obstruction (MVO) and using automated extracellular volume fraction (ECV) maps for reference. Furthermore, their performances on the acute scan were compared against manual myocardial infarct (MI) size to predict adverse left ventricular (LV) remodelling (≥20% increase in end-diastolic volume).

Methods 40 patients with reperfused ST segment elevation myocardial infarction (STEMI) with a paired acute (4±2 days) and follow-up CMR scan (5±2 months) were recruited prospectively. All CMR analysis was performed on CVI42.

Results Using manual MI size as the reference standard, 6-SD accurately quantified acute (24.9±14.0%LV, p=0.81, no bias) and chronic MI size (17.2±9.7%LV, p=0.88, no bias). The performance of FWHM for acute MI size was affected by the acquisition sequence used. Furthermore, FWHM underestimated chronic MI size in those with previous MVO due to the significantly higher ECV in the MI core on the follow-up scans previously occupied by MVO (82 (75–88)% vs 62 (51–68)%, p<0.001). 5-SD and Otsu were precise but overestimated acute and chronic MI size. All techniques were performed with high diagnostic accuracy and equally well to predict adverse LV remodelling.

Conclusions 6-SD was the most accurate for acute and chronic MI size and should be the preferred semiautomatic technique in randomised controlled trials. However, 5-SD, FWHM and Otsu could also be used when precise MI size quantification may be adequate (eg, observational studies).

  • Infarct size
  • Myocardial infarction
  • Microvascular obstruction
  • extracellular volume fraction
  • cardiovascular magnetic resonance

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/openhrt-2016-000535

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    Footnotes

    • Contributors All authors have contributed to the following four criteria: substantial contributions to the conception or design of the work, or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding This work was supported by the British Heart Foundation (FS/10/039/28270), the Rosetrees Trust and the National Institute for Health Research University College London Hospitals Biomedical Research Centre.

    • Competing interests None declared.

    • Ethics approval NRES Committee London—Harrow Health Research Authority.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.