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Tissue characterisation by cardiovascular magnetic resonance in ST-segment elevation myocardial infarction

Bulluck, H; (2017) Tissue characterisation by cardiovascular magnetic resonance in ST-segment elevation myocardial infarction. Doctoral thesis , UCL (University College London). Green open access

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Abstract

Acute ST-segment elevation myocardial infarction (STEMI) and its associated co-morbidities are among the leading causes of death and disability worldwide. We used multi-parametric mapping by cardiovascular magnetic resonance (CMR) to provide insights into the pathological processes underlying the ischaemic insult and LV remodelling. In Chapter 4 we showed that T1 mapping could quantify the AAR as well as T2 mapping. Secondly, the presence of a hypo-intense core on T1 or T2 maps performed equally well to detect intramyocardial haemorrhage (IMH). Lastly, we showed that post-contrast T1 maps could accurately delineate acute MI size. In chapter 5, we found that 6 standard deviations (SD) was the most accurate semi-automatic method both for acute and chronic MI size quantification using paired CMR scans. However, all 4 of the promising semi-automated techniques assessed (5-SD, 6SD, full width half maximum and Otsu) were equally precise. In chapter 6, we showed that the majority of patients with IMH had residual iron at follow-up and the latter was associated with adverse LV remodelling. Adverse LV remodelling itself was associated with delayed resolution of oedema in the MI zone. The remote extracellular volume fraction (ECV) was higher in the STEMI patients within the first week, when compared to controls, but only remained elevated in those patients who developed adverse LV remodelling. In Chapter 7, we obtained the minimal detectable changes for percentage change in LV end-diastolic volume (%ΔLVEDV – 12%) and %Δ in LV end-systolic volume (%ΔLVESV – 13%) in paired acute and follow-up STEMI patients. Combining %ΔLVEDV and %ΔLVESV revealed 4 patterns of LV remodelling. In conclusion, T1, T2 and T2* CMR mapping complement each other, and provide valuable insights into the pathophysiology of STEMI and adverse LV remodelling. These parameters could be used to risk-stratify, assess response to treatment and for prognostication in reperfused STEMI patients.

Type: Thesis (Doctoral)
Title: Tissue characterisation by cardiovascular magnetic resonance in ST-segment elevation myocardial infarction
Event: University College London
Open access status: An open access version is available from UCL Discovery
Language: English
Keywords: Cardiovascular magnetic resonance, T1 mapping, T2 mapping, T2* mapping, ECV mapping, ST-segment elevation myocardial infarction, Area at risk, Microvascular obstruction, Intramyocardial hemorrhage, Left ventricular remodelling, Infarct size, Myocardial salvage
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Pre-clinical and Fundamental Science
URI: https://discovery.ucl.ac.uk/id/eprint/1539982
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