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Original Articles

Sequential Changes of Myocardial Microstructure in Patients Postmyocardial Infarction by Diffusion-Tensor Cardiac MR

Correlation With Left Ventricular Structure and Function

Ming-Ting Wu, MD; Mao-Yuan M. Su, MS; Yi-Luan Huang, MD; Kuan-Rau Chiou, MD; Pinchen Yang, MD; Huay-Ben Pan, MD; Timothy G. Reese, PhD; Van J. Wedeen, MD and Wen-Yih I. Tseng, MD, PhD

From the Faculty of Medicine (M.-T.W., Y.-L.H., K.-R.C.), School of Medicine, National Yang Ming University, Taipei; Department of Radiology (M.-T.W., Y.-L.H., H.-B.P.), Kaohsiung Veterans General Hospital, Kaohsiung; Department of Medical Imaging (M.-Y.M.S., W.-Y.I.T.), National Taiwan University Hospital, Taipei; Institute of Biomedical Engineering (M.-Y.M.S.), National Yang Ming University, Taipei; Section of Cardiology (K.-R.C.), Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung; Department of Psychiatry (P.Y.), College of Medicine, Kaohsiung Medical University and Kaohsiung Medical University Hospital, Kaohsiung; Department of Radiation Technology (H.-B.P.), College of Medical Sciences, I-Shou University, Kaohsiung, Taiwan, Republic of China; Department of Radiology (T.G.R., V.J.W.), Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Mass; and Center for Optoelectronic Biomedicine (W.-Y.I.T.), National Taiwan University College of Medicine, Taiwan, Republic of China.

Correspondence to Ming-Ting Wu, MD, Section of Thoracic and Circulation Imaging, Department of Radiology, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st Rd, Kaohsiung, Taiwan 813, Republic of China. E-mail wu.mingting{at}gmail.com, mingting.wu@isca.vghks.gov.tw, or co-correspondent Wen-Yih I Tseng, MD, PhD.

Received March 11, 2008; accepted November 6, 2008.

Background— We used diffusion-tensor cardiac MR to investigate myocardial microstructure changes, including tissue integrity (mean diffusivity [MD], fractional anisotropy) and fiber architecture (helix angles) in patients with recent myocardial infarction (MI). This study aimed to investigate the sequential changes of myocardial microstructure and its relationships with changes of macrostructure and function of the left ventricle post-MI.

Methods and Results— Seventeen patients (age, 55.1±11.5 years; all men) participated in the follow-up study. Diffusion-tensor cardiac MR, cine gradient echo for left ventricle function, and late gadolinium enhancement for viability were measured from recent to chronic MI (median interval, 191 days). When compared with the remote zone, the infarct-adjacent zone showed overall increase of MD (2-way MANOVA, F_1,16=36.3; P<0.001), decrease of fractional anisotropy (F_1,16=5.8; P=0.029), and decrease of mean helix angles (F_1,16=62.0; P<0.001). From recent to chronic MI, there was overall sequential decrease of MD (F_1,16=22.6; P<0.001) and increase of fractional anisotropy (F_1,16=7.8; P=0.013). Multiple linear regression showed that the improvement of wall thickening in the infarct-adjacent zone correlated with sequential decrease of MD in the infarct-adjacent zone (r=–0.70; P=0.002) and increase of mean helix angles (ie, more right-handed helical myofiber reorientation, predominantly subendocardial location) in the remote zone (r=0.60; P=0.011). Likewise, wall thickening in the remote zone correlated with MD in the remote zone (r=–0.72; P=0.001) and mean helix angles in the infarct-adjacent zone (r=0.72; P=0.001).

Conclusion— Diffusion-tensor cardiac MR suggests that sequential zonal improvement of tissue integrity and fiber architecture remodeling both associate with sequential recovery of zonal wall thickening of the left ventricle from recent to chronic MI.

Key Words: imaging • magnetic resonance imaging • myocardial infarction • remodeling

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