We read with interest the article by Steuer et al., recently published in the Journal. 1 The authors attempted to visualize and quantify the amount of irreversible myocardial injury related to the coronary artery bypass procedure using delayed enhancement cardiovascular magnetic resonance (CMR). As suggested by the authors and the related editorial in the Journal, 2 the clinical utilization of this approach would be confounded by the inability of delayed enhancement to differentiate acute, newly developing infarcts from chronic myocardial scars.

We have recently described an imaging approach that can be of great help in this setting. 3 Combining delayed enhancement with corresponding T2-weighted CMR enabled us to differentiate acute from chronic myocardial infarction with 96% specificity. The approach relies on the ability of T2-weighted sequences to accurately identify myocardial oedema, a feature of acute but not of chronic myocardial infarcts. Accordingly, acute infarcts consistently exhibit transmural high T2 signal intensity together with delayed enhancement. We believe that this imaging approach could thus obviate the need to double-scan the patients (before and after coronary revascularization) and would overcome the known limitations of ECG, echocardiography and radionuclide imaging in this clinical setting.