The transmural extent of LGE in each segment predicts recovery after revascularisation: < 25% likely to recover, > 50% unlikely — report per segment on the 17-segment model with LV volumes and EF.
Orient first
- Infarct LGE is subendocardial, extending towards the epicardium in a coronary territory.
- Dysfunctional segments with little LGE are viable (hibernating or stunned).
- Low-dose dobutamine contractile reserve adds information in intermediate segments (verify local practice).
Acquire the study
- CMR: cine short-axis stack; LGE (PSIR) 10–15 min after gadolinium in short axis and long axes; microvascular obstruction on early gadolinium imaging.
The manoeuvre
- Cine: wall motion per segment (normal, hypo-, a-, dyskinetic) and end-diastolic wall thickness in mm.
- LGE per segment: transmural extent 0, 1–25, 26–50, 51–75, 76–100%.
- Microvascular obstruction (dark core) on early and late gadolinium.
- LV thrombus; LV volumes and EF indexed.
- Summarise the number of viable dysfunctional segments per territory.
What confirms it
- A segmental map of transmurality that matches the coronary anatomy.
What licenses you to exclude it
- No LGE in dysfunctional segments means viable myocardium (or a non-ischaemic cause).
The classic misread
- Wrong inversion time making the whole myocardium grey — scar underestimated.