Sustained postinfarction myocardial oedema in humans visualised by magnetic resonance imaging

Abstract

Objective: To demonstrate postinfarction myocardial oedema in humans with particular reference to the longitudinal course, using magnetic resonance imaging (MRI).

Design: Prospective observational study. Subjects were studied one week, one month, three months, six months, and one year after presenting with a myocardial infarct.

Setting: Cardiology and magnetic resonance departments in a Danish university hospital.

Patients: 10 patients (three women, seven men), mean (SEM) age 58.2 (3.20) years, with a first transmural myocardial infarct.

Main outcome measures: Location and duration of postinfarction myocardial oedema.

Results: All patients had signs of postinfarction myocardial oedema. The magnetic resonance images were evaluated by two blinded procedures, employing two MRI and two ECG observers: (1) MRI determined oedema location was compared with the ECG determined site of infarction and almost complete agreement was found; (2) the time course of postinfarction myocardial oedema was explored semiquantitatively, using an image ranking procedure. Myocardial oedema was greatest at the initial examination one week after the infarction, with a gradual decline during the following months (Spearman's rank correlation analysis: rho(observer 1) = 0.94 (p < 0.0001) and rho(observer 2) = 0.97 (p < 0.0001)). The median duration of oedema was six months.

Conclusions: Postinfarction myocardial oedema seems surprisingly long lasting. This observation is of potential clinical interest because the oedema may have prognostic significance.

Figure 1

The course of postinfarction myocardial oedema (table 1, patient 9). Corresponding slices of the right and left ventricles positioned in the true short axis at mid-ventricular level from four succeeding examinations. (A) Seventh day post-myocardial infarction; (B) one month; (C) three months; (D) six months. The high signal intensity (bright) areas within the myocardium represent oedema. Notice the large extent of oedema on the seventh day affecting particularly the septum and anterior wall of the left ventricle, and the gradual decline of the oedema over the following months.