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The assessment of myocardial salvage is an important measure in the evaluation of the efficacy of therapeutic approaches, including coronary reperfusion and cardioprotective measures 1,2 and an adequate myocardial salvage volume is associated with better short- and long-term outcome and survival after myocardial infarction 4.
Myocardial salvage can be assessed with different methods e.g. with cardiac magnetic resonance 1-6, SPECT and/or a combination of angiographic assessment and biochemical ischemia markers or other imaging modalities 6.
In MRI myocardial salvage can be assessed if either the myocardial area at risk and the definite size of a myocardial infarct are known 1-7 or can be estimated from the endocardial surface length if late gadolinium enhancement (LGE) is not too small 7.
If the definite infarct size is subtracted from the myocardial area at risk the amount of salvaged myocardium can be obtained 1,2.
Late gadolinium enhancement can be considered a valid surrogate for infarct size. Different methods to assess myocardial area at risk have been described, the 'myocardial edema based approach' with means of T2/STIR or myocardial mapping to calculate myocardial salvage has been commonly used but discouraged as an endpoint for clinical trials 7.
The endocardial surface length can be calculated from late gadolinium enhancement and used to estimate myocardial salvage as the viable myocardium within the circumferential extent of the infarct 7.
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- 2. Friedrich M, Abdel-Aty H, Taylor A, Schulz-Menger J, Messroghli D, Dietz R. The Salvaged Area at Risk in Reperfused Acute Myocardial Infarction as Visualized by Cardiovascular Magnetic Resonance. J Am Coll Cardiol. 2008;51(16):1581-7. doi:10.1016/j.jacc.2008.01.019 - Pubmed
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- 4. Eitel I, Desch S, de Waha S et al. Long-Term Prognostic Value of Myocardial Salvage Assessed by Cardiovascular Magnetic Resonance in Acute Reperfused Myocardial Infarction. Heart. 2011;97(24):2038-45. doi:10.1136/heartjnl-2011-300098 - Pubmed
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- 6. Ibanez B, Aletras A, Arai A et al. Cardiac MRI Endpoints in Myocardial Infarction Experimental And Clinical Trials. J Am Coll Cardiol. 2019;74(2):238-56. doi:10.1016/j.jacc.2019.05.024 - Pubmed
- 7. Ubachs J, Engblom H, Erlinge D et al. Cardiovascular Magnetic Resonance of the Myocardium at Risk in Acute Reperfused Myocardial Infarction: Comparison of T2-Weighted Imaging Versus the Circumferential Endocardial Extent of Late Gadolinium Enhancement with Transmural Projection. J Cardiovasc Magn Reson. 2010;12(1):18. doi:10.1186/1532-429X-12-18 - Pubmed