Assessment of acute myocardial infarction: current status and recommendations from the North American society for Cardiovascular Imaging and the European Society of Cardiac Radiology

Abstract

There are a number of imaging tests that are used in the setting of acute myocardial infarction and acute coronary syndrome. Each has their strengths and limitations. Experts from the European Society of Cardiac Radiology and the North American Society for Cardiovascular Imaging together with other prominent imagers reviewed the literature. It is clear that there is a definite role for imaging in these patients. While comparative accuracy, convenience and cost have largely guided test decisions in the past, the introduction of newer tests is being held to a higher standard which compares patient outcomes. Multicenter randomized comparative effectiveness trials with outcome measures are required.

Fig. 1

Example of a 76 year old male patient with an acute myocardial infarction (STEMI) of the anterior wall after acute PCI of the occluded LAD with stent implantation (pain-to-balloon time 150 min.). a The water sensitive T2-STIR image demonstrates the edema in the anterior wall (white arrows), c the LGE images demonstrate an almost transmural myocardial infarction (white arrows) with central MVO (asterisk). This indicates almost no myocardial salvage after successful revascularization of the LAD. b shows the T2* image at TE = 15 ms and d the T2* imaging map of the T2* mapping. The central dark area (white arrow) represents pixels with a T2* decay <20 ms indicating postreperfusionhemorrhage

Fig. 2

CMR of a 20 year old man with biopsy proven acute myocarditis. a Demonstrates the typical finding of a subepicardialedema (white arrows) and LGE, b, c indicating acute myocardial inflammation and irreversible cell death

Fig. 3

Cine CMR images of a 40 year old female patient during diastole (a) and systole (b) acquired at acute phase of takotsubocardiomyopathy (TTC) demonstrating apical ballooning (black arrows) in the absence of LGE (c). A repeated Cine CMR 3 months later (d) showed complete normalization of systolic ventricular function

Fig. 4

Example of acute MI due to occlusion of an obtuse marginal artery [126]. First pass MSCT shows local hypoenhancement of the antero-lateral wall. This perfusion defect was leading to find the culprit lesion in a 3 vessel disease patient

Fig. 5

Post-angioplasty MSCT without reinjection of contrast medium, showing transmuralantero-septal contrast uptake, involving papillary muscle (asterisk). This finding predicts poor recovery of the antero-septal wall