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Myocardium at risk in ST-segment elevation myocardial infarction comparison of T2-weighted edema imaging with the MR-assessed endocardial surface area and validation against angiographic scoring.
- Source :
-
JACC. Cardiovascular imaging [JACC Cardiovasc Imaging] 2011 Sep; Vol. 4 (9), pp. 967-76. - Publication Year :
- 2011
-
Abstract
- Objectives: The objective of this study was to assess the area at risk (AAR) in ST-segment elevation myocardial infarction with 2 different cardiac magnetic resonance (CMR) imaging methods and to compare them with the validated angiographic Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease Score (APPROACH-score) in a large consecutive patient cohort.<br />Background: Edema imaging with T(2)-weighted CMR and the endocardial surface area (ESA) assessed by late gadolinium enhancement have been introduced as relatively new methods for AAR assessment in ST-segment elevation myocardial infarction. However, data on the utility and validation of these techniques are limited.<br />Methods: A total of 197 patients undergoing primary percutaneous coronary intervention in acute ST-segment elevation myocardial infarction were included. AAR (assessed with T(2)-weighted edema imaging and the ESA method), infarct size, and myocardial salvage (AAR minus infarct size) were determined by CMR 2 to 4 days after primary angioplasty. Angiographic AAR scoring was performed by use of the APPROACH-score. All measurements were done offline by blinded observers.<br />Results: The AAR assessed by T(2)-weighted imaging showed good correlation with the angiographic AAR (r = 0.87; p < 0.001), whereas the ESA showed only a moderate correlation either to T(2)-weighted imaging (r = 0.56; p < 0.001) or the APPROACH-score (r = 0.44; p < 0.001). Mean AAR by ESA (20.0 ± 11.7% of left ventricular mass) was significantly (p < 0.001) smaller than the AAR assessed by T(2)-weighted imaging (35.6 ± 10.9% of left ventricular mass) or the APPROACH-score (27.9 ± 10.5% of left ventricular mass) and showed a significant negative dependence on myocardial salvage index. In contrast, no dependence of T(2)-weighted edema imaging or the APPROACH-score on myocardial salvage index was seen.<br />Conclusions: The AAR can be reliably assessed by T(2)-weighted CMR, whereas assessment of the AAR by ESA seems to be dependent on the degree of myocardial salvage, thereby underestimating the AAR in patients with high myocardial salvage such as aborted infarction. Thus, assessment of the AAR with the ESA method cannot be recommended. (Myocardial Salvage and Contrast Dye Induced Nephropathy Reduction by N-Acetylcystein [LIPSIA-N-ACC]; NCT00463749).<br /> (Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Angioplasty, Balloon, Coronary
Contrast Media
Edema, Cardiac diagnostic imaging
Edema, Cardiac pathology
Female
Germany
Humans
Male
Middle Aged
Myocardial Infarction diagnostic imaging
Myocardial Infarction pathology
Myocardial Infarction therapy
Organometallic Compounds
Predictive Value of Tests
Prospective Studies
Reproducibility of Results
Risk Assessment
Risk Factors
Treatment Outcome
Coronary Angiography
Edema, Cardiac diagnosis
Magnetic Resonance Imaging
Myocardial Infarction diagnosis
Myocardium pathology
Subjects
Details
- Language :
- English
- ISSN :
- 1876-7591
- Volume :
- 4
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- JACC. Cardiovascular imaging
- Publication Type :
- Academic Journal
- Accession number :
- 21920334
- Full Text :
- https://doi.org/10.1016/j.jcmg.2011.02.023