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Myocardial oedema - a new diagnostic target?

  • T2-weighted cardiovascular magnetic resonance and T2 mapping of myocardial oedema, presented by A H Aletras (Lamia, GR) - Slides
  • Cardiovascular magnetic resonance in acute myocardial infarction, presented by A Arai (Bethesda, US) - Slides
  • Cardiovascular magnetic resonance of the area at risk and myocardial salvage, presented by I Eitel (Leipzig, DE) - Slides
  • Importance of microvascular obstruction on images and prognosis, presented by J Bogaert (Leuven, BE) - Slides
Non-invasive Imaging: Magnetic Resonance Imaging

More than 120 ESC participants attended the session on myocardial oedema as a novel diagnostic target in acute heart disease. Recent studies using Cardiovascular Magnetic Resonance (CMR) to non-invasively detect and quantify the extent of myocardial oedema in acute myocardial infarction and acute myocarditis have raised huge interest in the cardiology community.

The chairs, Håkan Arheden and Matthias Friedrich welcomed an impressive international speaker panel. Dr. Anthony Aletras set the stage by discussing the pathophysiology of myocardial oedema and the different available diagnostic approaches, concluding that, although current CMR techniques have been successfully applied, novel methods such as mapping relaxation times may be preferred in the future.

Dr. Andrew Arai discussed limitations of late enhancement (LGE) imaging in acute myocardial infarction, pointing out that the susceptibility of this technique to rapidly changing Gd kinetics in the salvaged area at risk during the first 5 to 7 minutes. In the discussion, the static approach of visualizing oedema by T2-weighted imaging was considered more robust.

Dr. Ingo Eitel reported about the current published evidence on the clinical utility of imaging myocardial salvage by CMR. He focused on the validation of techniques by animal studies and comparative clinical data, concluding that the salvaged myocardium at risk is indeed a valid diagnostic target.

Finally, Dr. Jan Bogaert addressed microvascular obstruction as another important prognostic marker in reperfused MI, which can be visualized by CMR and reported that comprehensive CMR scans including LV function, oedema, perfusion, necrosis and microvascular obstruction can be performed in little more than 30 minutes.

In conclusion, the speakers agreed that CMR oedema imaging has an important role as an endpoint in clinical trials and will increasingly be used for clinical decision-making.




Myocardial oedema - a new diagnostic target?

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.