Colors of Myocardial Infarction
Can They Predict the Future?
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Late gadolinium enhancement (LGE) cardiovascular magnetic resonance imaging (CMR) is a major achievement in the field of noninvasive cardiac imaging.1 During the past 2 decades, LGE has not only become the gold standard for characterizing myocardial infarctions (MIs), but it has also been shown to have significant value in predicting clinical outcomes after acute MI. However, a drawback of LGE is that it cannot discriminate between acute and chronic MI, which is a frequent demand in the clinical management of patients with MI. Over a decade ago, noncontrast-enhanced T2-based CMR emerged to fill this gap. Specifically, it was shown that the infarct zone hyperintensity in T2 images, suggestive of edema within the zone, normalizes to that of remote myocardium at 3 months post-MI, presumably because of the resolution of edema in the chronic phase of MI.2 Thus, a combined evaluation of LGE and T2 CMR has become an accepted strategy for differentiating between acute and chronic MIs.
See Article by Carberry et al
Despite these key advances, there have been evidence in the literature, albeit in small cohorts of patients, that the time for infarct zone T2 hyperintensity to resolve to remote values is highly variable3,4 and that infarct zone T2 hyperintensity can persist even 1 year after acute MI. These reports, however, did not provide insight into the temporal heterogeneity of edema resolution. The recent study by Bulluck et al5 has been instrumental in uncovering potential cues for why infarct zone T2 hyperintensity in some acute MIs can persist well after the acute phase of MI. They reported that in …