Two important changes regarding contrast enhanced MRI (ceMRI) of the heart have recently occurred. First, it is now recognized that segmented k-space inversion-recovery imaging pulse sequences result in image intensities in """"""""hyperenhanced"""""""" regions which are typically 500 percent higher than in """"""""non hyperenhanced"""""""" regions, greatly reducing observer subjectivity. Second, recent data suggest that healed myocardial infarcts hyperenhance. In preliminary studies, the applicants found that ceMRI detects both acute and chronic infarcts with a sensitivity approaching that of serum assays for cardiac enzymes. Unlike cardiac enzymes which are cleared from the blood in a few days, however, ceMRI provides a permanent record of infarction, localizes the infarct to a specific coronary artery territory, and can be combined with cine MRI to document the effect of the infarct on wall motion with perfect registration. In addition, preliminary results suggest that hyperenhancement may be specific for ischemic injury. The applicant studied patients with non-ischemic cardiomyopathy determined by coronary angiography. Despite profound ventricular dysfunction, hyperenhancement was not observed in these patients. Detailed analysis of the data from patients with ischemic and non-ischemic cardiomyopathy strongly suggested that, for patients with ischemic disease, the presence or absence of irreversible injury. To investigate this further, the applicants examined wall motion in patients before and after revascularization by CABG or PTCA. For the 804 segments with a baseline wall motion abnormality, the likelihood of recovery of wall motion after revascularization was strongly predicted by the presence or absence of hyperenhancement. These preliminary data underscore that ceMRI in combination with cine MRI can provide detailed diagnostic information. The applicants propose to establish the sensitivity of ceMRI to detect chronic infarction in patients (Aim 1), to test the hypothesis that recovery of wall motion following revascularization is predicted by ceMRI (Aim 2), and determine if ceMRI can distinguish between patients with ischemic and non-ischemic cardiomyopathy (Aim3).

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project (R01)
Project #
Application #
Study Section
Diagnostic Radiology Study Section (RNM)
Program Officer
Buxton, Denis B
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Duke University
Internal Medicine/Medicine
Schools of Medicine
United States
Zip Code
Romano, Simone; Judd, Robert M; Kim, Raymond J et al. (2018) Prognostic Implications of Mitral Annular Plane Systolic Excursion in Patients with Hypertension and a Clinical Indication for Cardiac Magnetic Resonance Imaging: A Multicenter Study. JACC Cardiovasc Imaging :
Romano, Simone; Judd, Robert M; Kim, Raymond J et al. (2018) Feature-Tracking Global Longitudinal Strain Predicts Death in a Multicenter Population of Patients With Ischemic and Nonischemic Dilated Cardiomyopathy Incremental to Ejection Fraction and Late Gadolinium Enhancement. JACC Cardiovasc Imaging 11:1419-1429
Romano, Simone; Judd, Robert M; Kim, Raymond J et al. (2018) Left Ventricular Long-Axis Function Assessed with Cardiac Cine MR Imaging Is an Independent Predictor of All-Cause Mortality in Patients with Reduced Ejection Fraction: A Multicenter Study. Radiology 286:452-460
Kim, Han W; Rehwald, Wolfgang G; Jenista, Elizabeth R et al. (2018) Dark-Blood Delayed Enhancement Cardiac Magnetic Resonance of Myocardial Infarction. JACC Cardiovasc Imaging 11:1758-1769
Klem, Igor; Heiberg, Einar; Van Assche, Lowie et al. (2017) Sources of variability in quantification of cardiovascular magnetic resonance infarct size - reproducibility among three core laboratories. J Cardiovasc Magn Reson 19:62
Romano, Simone; Judd, Robert M; Kim, Raymond J et al. (2017) Association of Feature-Tracking Cardiac Magnetic Resonance Imaging Left Ventricular Global Longitudinal Strain With All-Cause Mortality in Patients With Reduced Left Ventricular Ejection Fraction. Circulation 135:2313-2315
Jenista, Elizabeth R; Rehwald, Wolfgang G; Chaptini, Nayla H et al. (2017) Suppression of ghost artifacts arising from long T1 species in segmented inversion-recovery imaging. Magn Reson Med 78:1442-1451
Kim, Han W; Van Assche, Lowie; Jennings, Robert B et al. (2015) Relationship of T2-Weighted MRI Myocardial Hyperintensity and the Ischemic Area-At-Risk. Circ Res 117:254-65
Smulders, Martijn W; Bekkers, Sebastiaan C A M; Kim, Han W et al. (2015) Performance of CMR Methods for Differentiating Acute From Chronic MI. JACC Cardiovasc Imaging 8:669-79
White, James A; Kim, Han W; Shah, Dipan et al. (2014) CMR imaging with rapid visual T1 assessment predicts mortality in patients suspected of cardiac amyloidosis. JACC Cardiovasc Imaging 7:143-56

Showing the most recent 10 out of 42 publications