Current Guidelines for Diagnosis of AMI Chest pain ST change on EKG Cardiac Enzymes
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1 Noninvasive Cardiac Imaging in Myocardial Infarction Sangchol Lee Sungkyunkwan University Samsung Medical Center
2 Current Guidelines for Diagnosis of AMI Chest pain ST change on EKG Cardiac Enzymes
3 Do We Need Imaging for AMI Management? Confusing results on EKG Time needed d for enzymes to rise Chest pain - typical? atypical? Measurement of infarct size Post-PCI PCI complications Assessment of residual viable myocardium
4 Current Noninvasive Imaging Modalities for AMI Diagnosis Echocardiography Radionuclide perfusion scan Cardiac CT Cardiac MRI
5 Conventional Echocardiography Global LV function Regional wall motion for diagnosis i Complications of MI Myocardial area at risk Myocardial viability - stress echo
6 Survival of Patients with Acute MI Prognosis EF 40% EF >40% E/e E/e 15 1 Surviva al E/e > E/e > Follow-up (months) Follow-up (months) No. at risk Hillis et al: JACC 43(3):360, 2004 CP
7 Prognostic Value of E/E' After Acute MI In DTBT < E/e' 15 In DTBT 90 E/e' 15 h) al (death Surviva P=0.06 E/e' >15 h) al (death Surviva E/e' >15 P< Follow-up (days) Follow-up (days) Park SJ, Ting H, Oh JK Unpublished CP
8 Unconventional Echocardiography Myocardial strain imaging Contrast t echocardiography h
9 Strain Imaging Strain: Deformation of an object, relative to its original length = L - L 0 L = L0 L 0 L 0 L 0 If 10 cm original length is shortened to 7.5 cm, strain is (-) 25 %. Normal strain is > 20 %. CP
10 2D Speckle Tracking Image Normal Radial strain (SAX) K.Ogawa, T.Hozumi et al. AJC 2006 Transversal strain (A4) Aplio (SSA-770A, Toshiba Japan)
11 Longitudinal strain: normal case Display 4C 2C Lengthening APLAX Shortening Bull s Eye
12 Bull s Eye Mapping of Strain +20% Lengthening g -20% Shortening Anteroseptal MI (LAD) Inferolateral MI (LCX) Inferior MI (RCA)
13 Contrast Echocardiography h Perfusion Defect in the apical segments
14 Contrast Perfusion Echo for Viability 2 patients with Anterior STEMI and PCI Baseline Follow up
15 Is there apical thrombus?
16 CT for Myocardial Imaging Coronary CT angiography Arterial phase myocardial imaging i Myocardial motion interpretation Viability imaging with delayed enhancement
17 Role of CCT in AMI Evaluation of acute chest pain Myocardial viability
18
19 Quantification of Infarct Size
20 Myocardial Viability
21 Dual-Phase CT
22 Dual-Phase CT
23 CMR: Delayed Enhancement
24
25 Two Patients with Inferior STEMI Soon after PCI
26 Two Patients with Inferior STEMI After PCI and Follow-up
27 Two Patients with Inferior STEMI Follow-up Echo and Baseline MRI Small DE by Gd Large DE by Gd
28 Myocardial Function and DHE Transmural extent of infarction and contractility Marholdt, JACC 2003
29 All Dysfunctional Segments Segments with Severe Hypokinesia, Akinesia, i or Dyskinesia i Segments with Akinesia i or Dyskinesia i ility (% %) ontract oved co Impro (12 of 12) (128 of 148) (23 (256 of 28) of 329) (56 of (109 86) of 183) (45 of (29 of (9 of 20) 110) 68) (13 of (10 of 124) 103) (4 (1 of (0 of of 54) (0 of 58) 57) 46) Transmural extent of hyperenhancement (%) R. Kim et al NEJM 2000 CP
30 Prognosis Associated with DHE Chest pain without known OMI Post-STEMI Kwong, Circ 2006 Wu, Heart 2008
31 Additional Information: Microvascular Obstruction Sakuma, JMRI 2007
32 Functional Recovery after AMI and MO Nijveldt, JACC 2008
33 MO and Prognosis Wu, Circulation 1998
34 AMI with Edema Sakuma, JMRI 2007
35 T2WI for Edema in MI T2WI-triple IR Myoview Scan
36 Acute MI with Swelling T2WI
37 With a Newer Sequence Acute MI Chronic MI Kellman, Magn Reson Med 2007
38 Peri-Infarct Zone Enhancement (The Grey Zone) 2-3 SD >3 SD Yan AT et al. Circulation 2006;114;32-39.
39 STEMI? Chest and left arm pain for 1 hr. Increased Troponin
40 65 year old woman with chest pain
41 Cine Delayed Enhancement Courtesy of Siemens Med. Systems
42 Cardiac MRI New Technology Diffusion Tensor Imaging g Myocardial Strain Imaging
43 Evaluation of Chest Pain Prognosis Viability Imaging CAD Function Infarct size Unstable Hemodynamics and dc Complications CP
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