Delayed uptake and washout of contrast in non-viable infarcted myocardium shown with dynamic computed tomography

Sebastian Udholm, Sofie Laugesen, Peter Agger, Jesper Hønge, Morten Smerup, Nichlas Udholm, Hans Erik Bøtker, Morten Bøttcher


Background: Assessment of ischemic but potentially viable myocardium plays an important role in the planning of coronary revascularization. Until now SPECT, PET, and MRI have been used to identify viable myocardium. Computed tomography (CT) is increasingly used to diagnose coronary atherosclerosis.
Objective: To evaluate the feasibility of CT enhancement as a viability marker by investigating myocardial contrast distribution over time in pigs with experimentally induced antero-septal myocardial infarctions.
Methods: Twelve pigs were subjected to 60 minutes of balloon occlusion of the left anterior descending artery, followed by removal of the balloon and reperfusion. Four pigs died due to refractory ventricular fibrillation. After 6 weeks, dynamic cardiac CT was performed assessing both wall motion and contrast attenuation. Measurements of attenuation values in Hounsfield units (HU) in the infarct zone and the normal lateral wall were performed at 20 sec, and 1, 3, 5, 8 and 12 minutes after contrast injection.
Results: We found highly significant differences in attenuation values between the two zones at all-time points except t =1 minute (ANOVA P=0.85). The normal myocardium showed higher uptake- and washoutrates of contrast than the infarct zone (84±15 vs. 58±8 at 20 sec, P=0.0001 and 27±12 vs. 81±13 at 12 min, P=0.0001). Specifically, the ratio between early (20 sec) and late (12 min) uptake is a valid marker of viable myocardium. In all animals this ration was above one in the normal zone and below one in the infarct zone.
Conclusions: Delayed infarct related uptake and washout of contrast shows promise for future clinical application of CT in a combined assessment of coronary atherosclerosis and myocardial viability.