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Dynamic Changes of Edema and Late Gadolinium Enhancement After Acute Myocardial Infarction and Their Relationship to Functional Recovery and Salvage Index

Open access
Dall'Armellina, Erica, Karia, Nina, Lindsay, Alistair C., Karamitsos, Theodoros D., Ferreira, Vanessa, Robson, Matthew D., Kellman, Peter, Francis, Jane M., Forfar, Colin, Prendergast, Bernard D., Banning, Adrian P., Channon, Keith M., Kharbanda, Rajesh K., Neubauer, Stefan, Choudhury, Robin P.·2011·Circulation: Cardiovascular Imaging

Abstract

Background—: Changes in the myocardium in acute ischemia are dynamic and complex, and the characteristics of myocardial tissue on cardiovascular magnetic resonance in the acute setting are not fully defined. We investigated changes in edema and late gadolinium enhancement (LGE) with serial imaging early after acute myocardial infarction, relating these to global and segmental myocardial function at 6 months. Methods and Results—: Cardiovascular magnetic resonance scans were performed on 30 patients with ST-elevation–myocardial infarction treated by primary percutaneous coronary intervention at each of 4 time points: 12 to 48 hours; 5 to 7 days; 14 to 17 days; and 6 months. All patients showed edema at 24 hours. The mean volume of edema (% left ventricle) was 37±16 at 24 hours and 39±17 at 1 week, with a reduction to 24±13 ( P <0.01) by 2 weeks. Myocardial segments with edema also had increased signal on LGE at 24 hours (κ=0.77; P <0.001). The volume of LGE decreased significantly between 24 hours and 6 months (27±15% versus 22±12%; P =0.002). Of segments showing LGE at 24 hours, 50% showed resolution by 6 months. In segments with such a reduction in LGE, 65% also showed improved wall motion ( P <0.0001). The area of LGE measured at 6 months correlated more strongly with troponin at 48 hours ( r =0.9; P <0.01) than LGE at 24 hours ( r =0.7). The difference in LGE between 24 hours and 6 months had profound effects on the calculation of salvage index (26±21% at 24 hours versus 42±23% at 6 months; P =0.02). Conclusions—: Myocardial edema is maximal and constant over the first week after myocardial infarction, providing a stable window for the retrospective evaluation of area at risk. By contrast, myocardial areas with high signal intensity in LGE images recede over time with corresponding recovery of function, indicating that acutely detected LGE does not necessarily equate with irreversible injury and may severely underestimate salvaged myocardium.

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Metadata

Authors
Dall'Armellina, E., Karia, N., Lindsay, A. C., Karamitsos, T. D., Ferreira, V., Robson, M. D., Kellman, P., Francis, J. M., Forfar, C., Prendergast, B. D., Banning, A. P., Channon, K. M., Kharbanda, R. K., Neubauer, S., & Choudhury, R. P.
Venue
Circulation: Cardiovascular Imaging
Published
2011-05
Volume
4
Issue
3
Pages
228-236
ISSN
  • 1941-9651 (ISSN-L)
  • 1942-0080
OpenAlex
W2121706860
Cited by
256
References
25
FWCI
14.94
Type
journal article
Language
en
Open access
green

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CoChat. (2026). Citation check: Dynamic Changes of Edema and Late Gadolinium Enhancement After Acute Myocardial Infarction and Their Relationship to Functional Recovery and Salvage Index. https://app.cochat.ai/papers/10.1161/circimaging.111.963421
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Dall'Armellina, E., Karia, N., Lindsay, A. C., Karamitsos, T. D., Ferreira, V., Robson, M. D., Kellman, P., Francis, J. M., Forfar, C., Prendergast, B. D., Banning, A. P., Channon, K. M., Kharbanda, R. K., Neubauer, S., & Choudhury, R. P. (2011). Dynamic Changes of Edema and Late Gadolinium Enhancement After Acute Myocardial Infarction and Their Relationship to Functional Recovery and Salvage Index. Circulation: Cardiovascular Imaging. https://doi.org/10.1161/circimaging.111.963421

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Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).

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