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Cardiovascular magnetic resonance of asymptomatic myocardial infarction
International Journal of Cardiology 93 (2004) 79 – 80 www.elsevier.com/locate/ijcard
Letter to the Editor
Cardiovascular magnetic resonance of asymptomatic myocardial infarction Burkhard Sievers a,*, Bodo Brandts a, James C. Moon b, Dudley J. Pennell b, Hans-Joachim Trappe a a
Department of Cardiology and Angiology, University of Bochum, Ho¨lkeskampring 40, D-44625 Herne, Germany b Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK Received 24 October 2002; accepted 24 December 2002
A 68-year-old male patient with electrocardiographically suspected ischemic heart disease was referred for coronary angiography, following a routine insurance check-up medical examination. He was in good health without any cardiac symptoms but his ECG suggested an old inferior myocardial infarction. The coronary angiogram demonstrated subtotal occlusion of the proximal right coronary artery and inferior wall motion abnormality (Fig. 1). The time of occurrence of the previous infarction was unknown. Cardiovascular Magnetic Resonance (CMR) was performed to assess cardiac function and to examine for the
extent of the infarcted myocardium. Cine imaging demonstrated markedly reduced left ventricular function with dyskinesis and aneurysmatic bulging of the thinned inferior wall (arrows Fig. 2A, C, E). After Gadolinium-DTPA contrast injection, delayed enhancement imaging was performed. There was predominant transmural hyperenhancement of the inferolateral myocardial wall (arrows), indicating full thickness infarction, with marked subendocardial extension inferoseptally (Fig. 2B, D, F). Interventional therapy with stenting of the distal right coronary artery was performed to allow reperfusion of nontransmural infarcted myocardium and improvement of left
Fig. 1. Coronary angiogram demonstrates subtotal occlusion of the distal right coronary artery.
* Corresponding author. Tel.: +49-2323-4990; fax: +49-2323-499301 E-mail address: [email protected] (B. Sievers). 0167-5273/$ - see front matter D 2003 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/S0167-5273(03)00122-0
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B. Sievers et al. / International Journal of Cardiology 93 (2004) 79–80
Fig. 2. (A, B): Gradient-echo-cine image (TrueFISP) in the vertical long axis view shows severely reduced left ventricular function with dyskinesis and aneurysmatic bulging (2A – arrows) of the thinned inferior wall. Contrast magnetic resonance shows inferior late enhancement after Gadolinium-DTPA injection in the same section plane (2B). (C, D): Gradient-echo image (TrueFISP), basal short axis view with thinned and aneurysmatic inferior wall (2C), and the corresponding plane using late hyperenhancement (2D) indicating transmural infarction inferolaterally (2D – long arrow), and subendocardial infarction inferoseptally (2D – short arrows). (E, F): Gradient-echo image (TrueFISP), midventricular short axis view at the level of the papillary muscles (2E) again shows dyskinesis. Again there is mainly transmural hyperenhancement of the inferior wall (2F long arrow), with subendocardial infarction of the inferoseptal region (short arrows 2F).
ventricular function. Follow up studies will be required to prove success or failure. This case indicates the use of contrast enhanced magnetic resonance to image clinically asymptomatic myocardial
infarction. The transmural resolution of CMR demonstrated the size and extension of the ventricular scar and was helpful in deciding the potential value of interventional therapy.
Letter to the Editor
Cardiovascular magnetic resonance of asymptomatic myocardial infarction Burkhard Sievers a,*, Bodo Brandts a, James C. Moon b, Dudley J. Pennell b, Hans-Joachim Trappe a a
Department of Cardiology and Angiology, University of Bochum, Ho¨lkeskampring 40, D-44625 Herne, Germany b Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK Received 24 October 2002; accepted 24 December 2002
A 68-year-old male patient with electrocardiographically suspected ischemic heart disease was referred for coronary angiography, following a routine insurance check-up medical examination. He was in good health without any cardiac symptoms but his ECG suggested an old inferior myocardial infarction. The coronary angiogram demonstrated subtotal occlusion of the proximal right coronary artery and inferior wall motion abnormality (Fig. 1). The time of occurrence of the previous infarction was unknown. Cardiovascular Magnetic Resonance (CMR) was performed to assess cardiac function and to examine for the
extent of the infarcted myocardium. Cine imaging demonstrated markedly reduced left ventricular function with dyskinesis and aneurysmatic bulging of the thinned inferior wall (arrows Fig. 2A, C, E). After Gadolinium-DTPA contrast injection, delayed enhancement imaging was performed. There was predominant transmural hyperenhancement of the inferolateral myocardial wall (arrows), indicating full thickness infarction, with marked subendocardial extension inferoseptally (Fig. 2B, D, F). Interventional therapy with stenting of the distal right coronary artery was performed to allow reperfusion of nontransmural infarcted myocardium and improvement of left
Fig. 1. Coronary angiogram demonstrates subtotal occlusion of the distal right coronary artery.
* Corresponding author. Tel.: +49-2323-4990; fax: +49-2323-499301 E-mail address: [email protected] (B. Sievers). 0167-5273/$ - see front matter D 2003 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/S0167-5273(03)00122-0
80
B. Sievers et al. / International Journal of Cardiology 93 (2004) 79–80
Fig. 2. (A, B): Gradient-echo-cine image (TrueFISP) in the vertical long axis view shows severely reduced left ventricular function with dyskinesis and aneurysmatic bulging (2A – arrows) of the thinned inferior wall. Contrast magnetic resonance shows inferior late enhancement after Gadolinium-DTPA injection in the same section plane (2B). (C, D): Gradient-echo image (TrueFISP), basal short axis view with thinned and aneurysmatic inferior wall (2C), and the corresponding plane using late hyperenhancement (2D) indicating transmural infarction inferolaterally (2D – long arrow), and subendocardial infarction inferoseptally (2D – short arrows). (E, F): Gradient-echo image (TrueFISP), midventricular short axis view at the level of the papillary muscles (2E) again shows dyskinesis. Again there is mainly transmural hyperenhancement of the inferior wall (2F long arrow), with subendocardial infarction of the inferoseptal region (short arrows 2F).
ventricular function. Follow up studies will be required to prove success or failure. This case indicates the use of contrast enhanced magnetic resonance to image clinically asymptomatic myocardial
infarction. The transmural resolution of CMR demonstrated the size and extension of the ventricular scar and was helpful in deciding the potential value of interventional therapy.