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. 2015 Feb 3;65(4):315-323.
doi: 10.1016/j.jacc.2014.11.004. Epub 2014 Nov 17.

Myocardial edema after ischemia/reperfusion is not stable and follows a bimodal pattern: imaging and histological tissue characterization

Rodrigo Fernández-Jiménez  1 , Javier Sánchez-González  2 , Jaume Agüero  3 , Jaime García-Prieto  3 , Gonzalo J López-Martín  3 , José M García-Ruiz  3 , Antonio Molina-Iracheta  3 , Xavier Rosselló  3 , Leticia Fernández-Friera  4 , Gonzalo Pizarro  5 , Ana García-Álvarez  3 , Erica Dall'Armellina  6 , Carlos Macaya  7 , Robin P Choudhury  6 , Valentin Fuster  8 , Borja Ibáñez  9
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Myocardial edema after ischemia/reperfusion is not stable and follows a bimodal pattern: imaging and histological tissue characterization

Rodrigo Fernández-Jiménez et al. J Am Coll Cardiol. .
Free article

Erratum in

  • Correction.
    [No authors listed] [No authors listed] J Am Coll Cardiol. 2018 Apr 17;71(15):1713. doi: 10.1016/j.jacc.2018.03.451. J Am Coll Cardiol. 2018. PMID: 29650129 No abstract available.

Abstract

Background: It is widely accepted that edema occurs early in the ischemic zone and persists in stable form for at least 1 week after myocardial ischemia/reperfusion. However, there are no longitudinal studies covering from very early (minutes) to late (1 week) reperfusion stages confirming this phenomenon.

Objectives: This study sought to perform a comprehensive longitudinal imaging and histological characterization of the edematous reaction after experimental myocardial ischemia/reperfusion.

Methods: The study population consisted of 25 instrumented Large-White pigs (30 kg to 40 kg). Closed-chest 40-min ischemia/reperfusion was performed in 20 pigs, which were sacrificed at 120 min (n = 5), 24 h (n = 5), 4 days (n = 5), and 7 days (n = 5) after reperfusion and processed for histological quantification of myocardial water content. Cardiac magnetic resonance (CMR) scans with T2-weighted short-tau inversion recovery and T2-mapping sequences were performed at every follow-up stage until sacrifice. Five additional pigs sacrificed after baseline CMR served as controls.

Results: In all pigs, reperfusion was associated with a significant increase in T2 relaxation times in the ischemic region. On 24-h CMR, ischemic myocardium T2 times returned to normal values (similar to those seen pre-infarction). Thereafter, ischemic myocardium-T2 times in CMR performed on days 4 and 7 after reperfusion progressively and systematically increased. On day 7 CMR, T2 relaxation times were as high as those observed at reperfusion. Myocardial water content analysis in the ischemic region showed a parallel bimodal pattern: 2 high water content peaks at reperfusion and at day 7, and a significant decrease at 24 h.

Conclusions: Contrary to the accepted view, myocardial edema during the first week after ischemia/reperfusion follows a bimodal pattern. The initial wave appears abruptly upon reperfusion and dissipates at 24 h. Conversely, the deferred wave of edema appears progressively days after ischemia/reperfusion and is maximal around day 7 after reperfusion.

Keywords: CMR; MRI; T2; myocardial infarction; pig; water content.

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