Magnetic Resonance Imaging of Myocardial Deformation and Scarring in Coronary Artery Disease

............................................................................................................ 1 SVENSK SAMMANFATTNING ........................................................................... 3 LIST OF PAPERS .................................................................................................. 5 ABBREVIATIONS ................................................................................................. 7 ACKNOWLEDGEMENTS .................................................................................... 9 INTRODUCTION ................................................................................................. 11 The physiology of the heart ........................................................................... 11 Myocardial infarction and heart failure ....................................................... 14 Magnetic resonance imaging ........................................................................ 16 The MRI experiment ......................................................................................... 16 The MRI pulse sequence ................................................................................... 17 The spin echo sequence .................................................................................... 18 The gradient echo sequence ............................................................................. 19 Inversion recovery ............................................................................................ 19 MRI safety ......................................................................................................... 19 Cardiovascular MRI ...................................................................................... 21 Late Gd enhancement ....................................................................................... 22 Strain and torsion ............................................................................................. 22 MRI from the patient perspective ................................................................ 27 Ethical considerations .................................................................................. 28 AIMS ..................................................................................................................... 31 METHODS .......................................................................................................... 33 Data collection ................................................................................................. 33 MRI ................................................................................................................... 34 MRI Analysis .................................................................................................... 35 Statistics ............................................................................................................ 37 RESULTS ............................................................................................................ 38 Paper 1 ............................................................................................................. 38 Paper 2 ............................................................................................................. 39 Magnetic Resonance Imaging of Myocardial Deformation and Scarring in Coronary Artery Disease. Paper 3 ............................................................................................................. 41 Paper 4 ............................................................................................................. 42 DISCUSSION ...................................................................................................... 43 Aspects of the results .................................................................................... 43 Paper 1 ............................................................................................................. 43 Paper 2 ............................................................................................................. 44 Paper 3 ............................................................................................................. 45 Paper 4 ............................................................................................................. 46 Methodological considerations .................................................................... 47 Statistical analyses ........................................................................................... 48 General discussion ........................................................................................... 48 CONCLUSIONS ................................................................................................... 51 REFERENCES .................................................................................................... 53