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The detection of myocardial oedema. Ready for clinicians?

Non-Invasive Imaging

I had the good fortune to participate in a very stimulating and active session on ischemic and non-ischemic myocardial oedema. The first speaker addressed the different techniques that can be proposed for the detection of this histopathologic aspect. While in recent years echocardiography and nuclear medicine have suggested the presence of myocardial oedema, it is only with Magnetic Resonance that this entity is rapidly becoming  a new diagnostic feature and clinically relevant. In fact, despite the technical difficulties, the presence of myocardial oedema can be detected by T2 images and namely with Triple Inversion Recovery images where the oedema appears bright with respect to the myocardium which is black.

The second speaker addressed the possibility of obtaining such images in acute patients (acute myocardial infarction, myocarditis, etc). He also introduced the concept that this technique has the unique possibility to differentiate between the infarct size and the area at risk, the latter corresponding to the oedematous area. Based on this information the different possible treatments in myocardial infarction can be evaluated in terms of efficacy.

The third speaker underlined extensively the relationship between the infarct size and the area at risk, addressing the different possibilities to measure both by MRI, differentiating clearly between tissue that is lost and tissue that is still viable, albeit with an impaired pathophysiological status.
Finally the fourth speaker underlined the differences between ischemic and non ischemic oedema in terms of distribution, pattern, etc.

The general agreement among the experts participating in the sessions was that by this technique we can obtain precious and unique information to be used in the clinical setting. However, from the very interactive discussion, it emerged also that this technique is so new that we have to better characterize the different possible aspects and link them to different possible pathophysiological situations.

In conclusion, the impression I had from these excellent talks was that we have in our hands a new tool for better assessment of the histopathological status of the myocardium in several acute diseases. This tool is working properly and it is robust enough to be proposed for use in the clinical arena, for better treatment strategy as well as better risk definition. Furthermore, it opens a new window in the understanding of acute myocardial injury.




The detection of myocardial oedema. Ready for clinicians?

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.