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Functional Recovery After Acute Myocardial Infarction Comparison Between Angiography, Electrocardiography, and Cardiovascular Magnetic Resonance Measures of Microvascular Injury

Authors :
Nijveldt, Robin
Beek, Aernout M.
Hirsch, Alexander
Stoel, Martin G.
Hofman, Mark B. M.
Umans, Victor A. W. M.
Algra, Paul R.
Twisk, Jos W. R.
van Rossum, Albert C.
Cardiology
Source :
Journal of the American College of Cardiology, 52(3), 181-189. Elsevier USA
Publisher :
American College of Cardiology Foundation. Published by Elsevier Inc.

Abstract

OBJECTIVES: We examined the relation between angiographic, electrocardiographic, and gadolinium-enhanced cardiovascular magnetic resonance (CMR) characteristics of microvascular obstruction (MVO), and their predictive value on functional recovery after acute myocardial infarction (AMI). BACKGROUND: Microvascular obstruction on CMR has been shown to predict left ventricular (LV) remodeling, but it is not well known how it compares with commonly used criteria of microvascular injury, and earlier reports have produced conflicting results on the significance and extent of MVO. METHODS: Thrombolysis In Myocardial Infarction (TIMI) flow grade, myocardial blush grade (MBG), and ST-segment resolution were assessed in 60 patients with AMI treated with primary stenting. Cardiovascular magnetic resonance was performed between 2 and 9 days after revascularization to determine early MVO on first-pass perfusion imaging, late MVO on late gadolinium-enhanced imaging, and infarct size and transmural extent. Cine imaging was used to determine LV volumes and global and regional function at baseline and 4-month follow-up. RESULTS: Early and late MVO were both related to incomplete ST-segment resolution (p = 0.002 and p = 0.01, respectively), but not to TIMI flow grade and MBG. Of all angiographic, electrocardiographic, and CMR variables, late MVO was the strongest parameter to predict changes in end-diastolic volume (beta = 0.53; p = 0.001), end-systolic volume (beta = 8.67; p = 0.001), and ejection fraction (beta = 3.94; p = 0.006) at follow-up. Regional analysis showed that late MVO had incremental diagnostic value to transmural extent of infarction (odds ratio: 0.18; p

Details

Language :
English
ISSN :
07351097
Issue :
3
Database :
OpenAIRE
Journal :
Journal of the American College of Cardiology
Accession number :
edsair.dedup.wf.001..7f9d2a7c4cdf8222ee6a7903d0d9567a
Full Text :
https://doi.org/10.1016/j.jacc.2008.04.006