Quantitative characterization of myocardial infarction by cardiovascular magnetic resonance predicts future cardiovascular events in patients with ischemic cardiomyopathy

Abstract

Background: Cardiovascular magnetic resonance (CMR) can provide quantitative data of the myocardial tissue utilizing high spatial and temporal resolution along with exquisite tissue contrast. Previous studies have correlated myocardial scar tissue with the occurrence of ventricular arrhythmia. This study was conducted to evaluate whether characterization of myocardial infarction by CMR can predict cardiovascular events in patients with ischemic cardiomyopathy (ICM).

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

“…15) The absence of a significant relationship between infarct size and LV remodeling in our MI population without early revascularization is consistent with the findings of previous post-MI studies with heterogeneous populations regarding early revascularization. 3,6,8,9,[17][18][19] Our finding and the results of these studies may imply that in patients without early revascularization LV remodeling is mainly dependent on factors beyond infarct tissue characteristics. Such factors include persistent or recurrent ischaemia, pressure and volume overload hypertrophy, neurohormonal and biophysical factors, and genetic mechanisms such as adapted gene expression in the setting of heart failure.…”

“…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.…”

“…[3][4][5][6][7][8][9] Discrepancies between observations with different diagnostic techniques may reflect the fact that LV geometry and function after the MI result from a complex interaction of various factors, including successful early revascularization 10) which may limit unfavorable adaptive changes of the myocardium. [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. [20][21][22] In the present study, we investigated the relation between infarct tissue characteristics and LV remodeling in patients with versus without successful early revascularization in a population of consecutive patients who underwent CE-CMR examination.…”

Myocardial scar extent evaluated by cardiac magnetic resonance imaging in ICD patients: relationship to spontaneous VT during long-term follow-up

“…Due to latter mentioned reasons we did not focus on grey zone analysis, but rather total infarct volume in the presented study. Yokota and colleagues showed in their study that patients with a composite end-point of ventricular arrhythmia, syncope and death during a mean follow-up period of 20 ± 16 months had larger infarcts than patients without an end-point [26]. They did not find differences for left ventricular enddiastolic and end-systolic volumes and for left ventricular ejection fraction.…”