Myocardial salvage

Last revised by Joachim Feger on 26 Nov 2021

Myocardial salvage is referred to as the reversibly injured myocardium in a setting of myocardial ischemia and/or myocardial infarction, which remains non-infarcted after reperfusion 1-7.

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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