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.

Measurement

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.

Interpretation

If the definite infarct size is subtracted from the myocardial area at risk the amount of salvaged myocardium can be obtained ^1,2.

MRI

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.