Prognostic Value of a Comprehensive Cardiac Magnetic Resonance Assessment Soon After a First ST-Segment Elevation Myocardial Infarction

Bodı́, Vicente; Sanchís, Juan; Núñez, Julio; Mainar, Luis; López‐Lereu, María P.; Monmeneu, José V.; Rúmiz, Eva; Chaustre, Fabian; Trapero, Isabel; Hüsser, Oliver; Forteza, María J.; Chorro, Francisco J.; Llàcer, Àngel

doi:10.1016/j.jcmg.2009.03.011

Cited by 112 publications

(75 citation statements)

References 24 publications

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“…Recently, our group has demonstrated that transmural necrosis is a strong prognosticator for MACE after STEMI [26]. The present study confirms this finding and additionally shows that neither qualitative nor quantitative myocardial perfusion nor time consuming quantification of infarct mass afford incremental predictive value to that of visual transmural necrosis for prognostic use.…”

Section: Cmr and Late Lvef After Stemisupporting

confidence: 88%

Head to head comparison of quantitative versus visual analysis of contrast CMR in the setting of myocardial stunning after STEMI: implications on late systolic function and patient outcome

Hüsser

Bodı́

Sanchís

et al. 2010

Int J Cardiovasc Imaging

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To compare a quantitative assessment of contrast cardiovascular magnetic resonance (CMR) after ST-segment elevation myocardial infarction (STEMI) with visual analysis for predicting depressed ejection fraction (dEF) and major adverse cardiac events (MACE). 192 patients underwent CMR at 1 week and 6 months after STEMI. Three quantitative (initial slope, maximal signal intensity and contrast delay in first-pass imaging) and 2 visual perfusion indexes (hypoenhancement in first-pass and microvascular obstruction in late enhancement imaging (LE)) were determined. Quantification of infarct mass and visual assessment of the extent of transmural necrosis (ETN) were also performed. At 6 months, 69 patients displayed dEF. During follow-up (mean 655 days) 20 MACE (death, re-infarction, re-admission for heart failure) occurred. Perfusion quantification took longer (P < 0.001) and, in ROC curve analyses and the C-statistic, was not superior to visual perfusion analysis for predicting late EF or MACE (P = ns). Similarly, infarct size quantification was not superior to visual assessment of ETN (P = ns). In multivariate analyses, only visual assessment of ETN (per segment) predicted dEF (OR 1.30 95%CI [1.04-1.61], P = 0.02) and MACE (HR 1.38 95%CI [1.19-1.60], P < 0.001). Visual analysis of CMR after STEMI is not time consuming and predicts dEF and MACE comparable to quantification. ETN was the strongest parameter.

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Section: Cmr and Late Lvef After Stemisupporting

confidence: 88%

Head to head comparison of quantitative versus visual analysis of contrast CMR in the setting of myocardial stunning after STEMI: implications on late systolic function and patient outcome

Hüsser

Bodı́

Sanchís

et al. 2010

Int J Cardiovasc Imaging

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“…9 We and others have shown that late MO is associated with adverse remodeling, which in turn portends progressive LV dilation, dysfunction, and premature death. 10,12,[22][23] Few studies, however, have directly compared early and late MO in relation to remodeling and prognosis after AMI. Two small studies have, similar to our study, shown a higher prevalence of early than late MO, presumably because of diffusion of contrast into less dense areas of microvascular dysfunction; although correlations were reported between MO and parameters of LV function, neither study examined the influence of early and late MO on MACE.…”

Section: Discussionmentioning

confidence: 99%

“…22 In the absence of studies specifically powered to determine the predictive efficacy of early and late MO on MACE, we can only extrapolate from the relationships between MO and remodeling reported in this and previous studies that both early and late MO are likely to be associated with adverse outcome, although this would have to be proven in an appropriately designed trial. 10,12,22 A key aspect of post-MI care is the prediction of those patients in whom LV function may progressively deteriorate because such patients warrant more stringent follow-up and may be candidates for specific pharmacotherapy (for example, aldosterone antagonists) or even implanted cardioverterdefibrillators. Many studies (and guidelines) use LVEF as the criterion on which such decisions are made.…”

Section: Discussionmentioning

confidence: 99%

Microvascular Obstruction Remains a Portent of Adverse Remodeling in Optimally Treated Patients With Left Ventricular Systolic Dysfunction After Acute Myocardial Infarction

Weir

Murphy

Petrie

et al. 2010

Circ: Cardiovascular Imaging

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Background-Microvascular obstruction (MO) is associated with large acute myocardial infarction and lower left ventricular (LV) ejection fraction and predicts greater remodeling, but whether this effect is abolished by contemporary antiremodeling therapies is subject to debate. We examined the influence of several infarct characteristics, including MO, on LV remodeling in an optimally treated post-acute myocardial infarction cohort, using contrast-enhanced cardiac magnetic resonance. Methods and Results-One hundred patients (mean age, 58.9Ϯ12 years, 77% men) underwent contrast-enhanced cardiac magnetic resonance at baseline (Ϸ4 days) and at 12 and 24 weeks. The effects on LV remodeling (ie, change in LV end-systolic volume index [⌬LVESVi]) of infarct site, transmurality, endocardial extent, and the presence of early and late MO were analyzed. Mean baseline infarct volume index decreased from 34.0 (21.2) mL/m 2 to 20.9 (12.9) mL/m

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“…Bodi et al demonstrated that there is a meaningful difference between major cardiovascular events when comparing patients with 5 or more segments of transmural infarction with those with less involved myocardium (23% vs. 5%, p <0.001). 29 Furthermore, Wu et al have shown that left ventricular remodeling is a more powerful predictor of clinical events than systolic function in patients with acute myocardial infarction. During the 4-month MRI follow-up, all patients enrolled in this study presented an improvement in the ejection fraction (p = 0.002).…”

Section: Assessment Of Myocardial Viabilitymentioning

confidence: 99%

Cardiac Magnetic Resonance and Myocardial Viability: Why Is It so Important?

Rodean¹,

Beganu²,

Hodaş³

et al. 2017

Journal of Interdisciplinary Medicine

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For a better assessment of ischemic heart diseases, myocardial viability should be quantified. Current studies underline the importance and the evolution of several techniques and methods used in the evaluation of myocardial viability. Taking into account these considerations, the aim of this manuscript was to present the recent points of view regarding myocardial viability and its clinical significance in patients with ischemic cardiomyopathies and left ventricular dysfunction. On the other hand, the manuscript points out the role of magnetic resonance imaging (MRI), one of the most useful noninvasive imaging techniques, in the assessment of myocardial viability. By comparing the advantages and disadvantages of cardiac MRI, its usefulness can be better appreciated by the clinician. In the following years, it is considered that MRI will be an indispensable imaging tool in the assessment of ischemic heart disease, guiding interventions for revascularization and long-term risk stratification in patients with stable angina or myocardial infarction.

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Prognostic Value of a Comprehensive Cardiac Magnetic Resonance Assessment Soon After a First ST-Segment Elevation Myocardial Infarction

Abstract: A comprehensive CMR assessment is useful for stratifying risk soon after STEMI, but only the extent of systolic dysfunction and of transmural necrosis provide independent prognostic information.

Cited by 112 publications

References 24 publications

Head to head comparison of quantitative versus visual analysis of contrast CMR in the setting of myocardial stunning after STEMI: implications on late systolic function and patient outcome

Head to head comparison of quantitative versus visual analysis of contrast CMR in the setting of myocardial stunning after STEMI: implications on late systolic function and patient outcome

Microvascular Obstruction Remains a Portent of Adverse Remodeling in Optimally Treated Patients With Left Ventricular Systolic Dysfunction After Acute Myocardial Infarction

Cardiac Magnetic Resonance and Myocardial Viability: Why Is It so Important?

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