Infarct size by contrast enhanced cardiac magnetic resonance is a stronger predictor of outcomes than left ventricular ejection fraction or end-systolic volume index: prospective cohort study

Wu, Edwin; Ortiz, José T.; Tejedor, Paula; Lee, Daniel; Bucciarelli-Ducci, Chiara; Kansal, Preeti; Carr, James C.; Holly, Thomas A.; Lloyd‐Jones, Donald M.; Klocke, Francis J.; Bonow, Robert O.

doi:10.1136/hrt.2007.122622

Cited by 403 publications

(286 citation statements)

References 30 publications

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“…MI size,4, 5 presence of microvascular obstruction (MVO),6, 7 and myocardial salvage8, 9 assessed by cardiovascular magnetic resonance (CMR) performed in the first few days after reperfusion in STEMI patients have all been shown to be strong predictors of adverse left ventricular (LV) remodeling and development of heart failure.…”

Section: Introductionmentioning

confidence: 99%

Automated Extracellular Volume Fraction Mapping Provides Insights Into the Pathophysiology of Left Ventricular Remodeling Post–Reperfused ST‐Elevation Myocardial Infarction

Bulluck

Rosmini

Abdel‐Gadir

et al. 2016

JAHA

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BackgroundWhether the remote myocardium of reperfused ST‐segment elevation myocardial infarction (STEMI) patients plays a part in adverse left ventricular (LV) remodeling remains unclear. We aimed to use automated extracellular volume fraction (ECV) mapping to investigate whether changes in the ECV of the remote (ECVR emote) and infarcted myocardium (ECVI nfarct) impacted LV remodeling.Methods and ResultsForty‐eight of 50 prospectively recruited reperfused STEMI patients completed a cardiovascular magnetic resonance at 4±2 days and 40 had a follow‐up scan at 5±2 months. Twenty healthy volunteers served as controls. Mean segmental values for native T1, T2, and ECV were obtained. Adverse LV remodeling was defined as ≥20% increase in LV end‐diastolic volume. ECVR emote was higher on the acute scan when compared to control (27.9±2.1% vs 26.4±2.1%; P=0.01). Eight patients developed adverse LV remodeling and had higher ECVR emote acutely (29.5±1.4% vs 27.4±2.0%; P=0.01) and remained higher at follow‐up (28.6±1.5% vs 26.6±2.1%; P=0.02) compared to those without. Patients with a higher ECVR emote and a lower myocardial salvage index (MSI) acutely were significantly associated with adverse LV remodeling, independent of T1Remote, T1Core and microvascular obstruction, whereas a higher ECVI nfarct was significantly associated with worse wall motion recovery.Conclusions ECVR emote was increased acutely in reperfused STEMI patients. Those with adverse LV remodeling had higher ECVR emote acutely, and this remained higher at follow‐up than those without adverse LV remodeling. A higher ECVR emote and a lower MSI acutely were significantly associated with adverse LV remodeling whereas segments with higher ECVI nfarct were less likely to recover wall motion.

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Section: Introductionmentioning

confidence: 99%

Automated Extracellular Volume Fraction Mapping Provides Insights Into the Pathophysiology of Left Ventricular Remodeling Post–Reperfused ST‐Elevation Myocardial Infarction

Bulluck

Rosmini

Abdel‐Gadir

et al. 2016

JAHA

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“…Several pathophysiologic mechanisms have been suggested, nevertheless there is paucity of clinical markers that can characterize a hemodynamic milieu predictive of the risk of cardiac remodeling either following infarction (Nijveldt et al, 2009;Wu et al, 2008) or excessive sport activity (De Luca et al, 2011;Mihl et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

Comparative numerical study on left ventricular fluid dynamics after dilated cardiomyopathy

Mangual

Kraigher‐Krainer

Luca

et al. 2013

Journal of Biomechanics

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Results: The flow in DCM exhibited qualitative differences due to the weakness of the formed vortices in the large LV chamber. DCM and healthy subjects show significant volumetric differences; these also reflect inflow properties like the vortex formation time, energy dissipation, and sub-volumes describing flow transit. Proper normalization permitted to define purely fluid dynamics indicators that are not influenced by volumetric measures. Conclusion: Cardiac fluid mechanics can be evaluated by a combination of imaging and numerical simulation. This pilot study on pathological changes in LV blood motion identified intraventricular flow indicators based on pure fluid mechanics that could potentially be integrated with existing indicators of cardiac mechanics in the evaluation of disease progression.

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“…2,4,5,[14][15][16] In our study population, the strongest relationship between total infarct size and LVEF (r = -0.79, P < 0.01) was found in early revascularized patients (n = 10) with an infarct size ≥ 15% of the LV mass. This was also recently shown by Pride, et al, who found a similar relationship in MI patients with an infarct size ≥ 15% (r = -0.81, P < 0.001).…”

Section: Discussionmentioning

confidence: 85%

“…9) However, most previous CE-CMR studies that investigated the relationship between infarct size and cardiac remodeling did not measure the size of the peri-infarct zone. [2][3][4][5][6]8,9,[14][15][16]18,19) The only exception was a study by Heidary,et al,17) who found in a population of patients with ischemic cardiomyopathy, no significant relation between infarct tissue characteristics (including peri-infarct size) and both LV geometry and function.…”

Section: Discussionmentioning

confidence: 94%

“…[11][12][13] The effect of successful early revascularization on the relationship between infarct tissue characteristics versus LV remodeling is not completely known. While some investigators found significant correlations between infarct tissue characteristics and LV remodeling in patients with successful early revascularization, 2,4,5,[14][15][16] others found conflicting results in more heterogeneous study populations (Table I). 3,6,8,9,[17][18][19] Cardiovascular magnetic resonance (CMR) imaging in combination with the contrast enhancement (CE) technique allows accurate assessment of LV geometry and function as well as tissue characteristics such as size, heterogeneity, and transmurality of the myocardial scar.…”

mentioning

confidence: 88%

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Relationship Between Infarct Tissue Characteristics and Left Ventricular Remodeling in Patients With Versus Without Early Revascularization for Acute Myocardial Infarction as Assessed With Contrast-Enhanced Cardiovascular Magnetic Resonance Imaging

et al. 2012

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SummaryLeft ventricular (LV) remodeling following myocardial infarction (MI) is the result of complex interactions between various factors, including presence or absence of early revascularization. The impact of early revascularization on the relationship between infarct tissue characteristics and LV remodeling is incompletely known. Therefore, we investigated in patients with versus without successful early revascularization for acute MI potential relations between infarct tissue characteristics and LV remodeling with contrast-enhanced (CE) cardiovascular magnetic resonance (CMR). Patients with versus without successful early revascularization underwent CE-CMR for tissue characterization and assessment of LV remodeling including end-diastolic and end-systolic volumes, LV ejection fraction, and wall motion score index (WMSI). CE-CMR images were analyzed for infarct tissue characteristics including core-, peri-and total-infarct size, transmural extent, and regional scar scores. In early revascularized patients (n = 46), a larger area of infarct tissue correlated significantly with larger LV dimensions and a more reduced LV function (r = 0.39-0.68; all P ≤ 0.01). Multivariate analyses identified peri-infarct size as the best predictor of LV remodeling parameters (R 2 = 0.44-0.62). In patients without successful early revascularization (n = 47), there was no correlation between infarct area and remodeling parameters; only peri-infarct size versus WMSI (r = 0.33; P = 0.03) and transmural extent versus LVEF (r = -0.27; P = 0.07) tended to be related. A correlation between infarct tissue characteristics and LV remodeling was found only in patients with early successful revascularization. Peri-infarct size was found to be the best determinant of LV remodeling. Our findings stress the importance of taking into account infarct tissue characteristics and success of revascularization when LV remodeling is studied. (Int Heart J 2012; 53: 263-269)

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Infarct size by contrast enhanced cardiac magnetic resonance is a stronger predictor of outcomes than left ventricular ejection fraction or end-systolic volume index: prospective cohort study

Abstract: Infarct size, EF and ESVI can predict the development of future cardiac events. Acute infarct size, which is independent of LV stunning and loading, directly relates to LV remodelling and is a stronger predictor of future events than measures of LV systolic performance.

Cited by 403 publications

References 30 publications

Automated Extracellular Volume Fraction Mapping Provides Insights Into the Pathophysiology of Left Ventricular Remodeling Post–Reperfused ST‐Elevation Myocardial Infarction

Automated Extracellular Volume Fraction Mapping Provides Insights Into the Pathophysiology of Left Ventricular Remodeling Post–Reperfused ST‐Elevation Myocardial Infarction

Comparative numerical study on left ventricular fluid dynamics after dilated cardiomyopathy

Relationship Between Infarct Tissue Characteristics and Left Ventricular Remodeling in Patients With Versus Without Early Revascularization for Acute Myocardial Infarction as Assessed With Contrast-Enhanced Cardiovascular Magnetic Resonance Imaging

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