The role of cardiac MRI in viability assessment

Introduction: T he study of myocardial viability is of great importance in the diagnosis and management of patients with ischemic cardiopathy requiring surgical myocardial revascularisation or angioplasty. The preci-se description of the myocardium, with or without vi-ability, is important in patients with low ejection fraction. It is known that the overall prognostic of patients with low ejection fraction is limited and the revascula-risation in patients with viability has the potential for contractile recovery.

Objective: To evaluate the importance and utility os cardioRM in myocardial viability.

Methods: The acquisition of delayed contrast-enhan-ced (DE) images of the myocardium in the short, long two-chamber, four chamber and three chamber is per-formed 10 minutes after infusion of gadolinium 0.10-0.20 mmol/kg. The viability is based on the measure-ment of the fibrosis area, its transmurality, the evaluati-on has been done on each segment using 17-segments model evaluation. There are different methods used to quantify the fibrosis, which may be visual (qualitative) or by means of a manual software or semiautomatic (with manual correction) or automatic (without any manual correction). On delayed enhancement, the area of contrast uptake equal or greater than 50% of the seg-mental area is considered as non-viable, whereas that below 50% is considered viable.

Results: We present different delayed contrast-enhanc-ment images in patients with low ejection fraction, in whom we used the qualitative method by visual assess-ment and semiautomatic evaluation using MEDIS software. The use of T1 mapping could be an alterna-tive for the description and evaluation of the fibrotic area. The use of CMR can assist in the assessment of cardiac complications, as we could see the presence of a thrombus at the apex level on the four-chamber DE image.

Conclusions: T here are different types of techniques that could be used in the evaluation of viable myocar-dium, which it is an important step before the medical decision of myocardial revascularisation. The correct detection of viable segments offer the possibility of re-covery of the contractility with improvement in ejecti-on fraction or the selection of the patients that could benefit from ICD implantation.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)