Purpose: To compare the relationship of myocardial edema and corresponding contractile function over time in patients with reperfused acute myocardial infarction (AMI).
Materials and methods: This study was approved by the regional ethics committee; all patients gave written informed consent. Thirty-nine patients (34 men; mean age, 57 years; age range, 35-73 years) underwent T2-weighted, tagging, and late gadolinium enhancement magnetic resonance imaging at three time points after primary percutaneous coronary intervention for ST-elevation AMI. Circumferential strain, T2-weighted signal intensity, and volume of infarct zones, peri-infarct zones, and remote myocardium were measured. Patients were stratified by presence or absence of peri-infarct edema, defined as areas with T2-weighted signal intensity of two or more standard deviations above that of remote myocardium. Statistical analysis was performed with repeated-measures analysis of variance with post hoc Bonferroni correction.
Results: Edematous peri-infarct myocardium had attenuated strain compared with remote myocardium at day 2 (-0.137 vs -0.226, P < .001), day 30 (-0.188 vs -0.240, P < .01), and day 90 (-0.207 vs -0.241, P = .01). Nonedematous peri-infarct myocardium had similar (P > .05) strain to remote myocardium at all time points. Strain improved in edematous peri-infarct myocardium at day 30 (P = .02) and day 90 (P < .01), closely mirroring resolution of intensity and volume of edema. Decreased strain correlated with edema volume (r = 0.30, P = .01) and normalized edema signal intensity (r = 0.28, P < .01). In eight patients with fully transmural infarction, infarct zone strain improved between day 2 and day 90 (P = .02).
Conclusion: Improvement of strain in peri-infarct myocardium closely follows regression of myocardial edema. Volume of edema and intensity of signal on T2-weighted images relate to functional recovery after reperfused AMI.