Acute myocardial infarction: early CT aspects of myocardial microcirculation obstruction after percutaneous coronary intervention
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To evaluate the capabilities of delayed enhanced multidetector CT (DE-MDCT), performed immediately after percutaneous coronary intervention (PCI), in predicting myocardial microvascular obstruction (MVO) formation assessed by delayed enhanced MRI (DE-MRI).
Thirty-two patients presenting with a primary acute myocardial infarction, successfully recanalised by PCI, underwent a DE-MDCT immediately after PCI and a DE-MRI within 1 week. The left ventricle was split into 64 subsegments, rated as “healthy”, “infarcted” or “MVO” on DE-MRI. Their mean density was measured on DE-MDCT and calculated relative to the patient's mean healthy myocardium density. Hypoenhanced DE-MDCT subsegments, termed “CT early MVO”, were also recorded. Sensitivity and specificity of DE-MDCT for MRI-assessed “MVO” subsegments detection was calculated for mean CT relative density (threshold determined from a ROC analysis), “CT early MVO” and both.
Mean CT relative density was higher in MRI-assessed “MVO” than in “infarcted” and “healthy” subsegments (1.82 ± 0.46, 1.43 ± 0.36 and 1.0 ± 0.13 respectively; P < 0.001) leading to a sensitivity and specificity of 94.3 % and 89.2 % for a cutoff of 1.36. Sensitivity and specificity were respectively 16.9 % and 99.8 % for “CT early MVO” and 95.3 % and 89.3 % when considering the two patterns.
DE-MDCT, performed immediately after PCI, allows for an accurate prediction of MVO formation.
• Myocardial microvascular obstruction (MVO) is an important prognostic sequel following myocardial infarction.
• MVO can be accurately predicted by multidector CT (MDCT).
• Both hypo- and hyperenhanced myocardial areas can be analysed by MDCT.
• MDCT may become a useful prognostic tool for acute MI outcome.
KeywordsCT systems, X-Ray computed Magnetic resonance imaging Myocardial infarction Myocardial microvascular obstruction Delayed enhancement
Delayed enhanced multidetector CT
Myocardial microvascular obstruction
Percutaneous coronary intervention
Delayed-enhanced magnetic resonance imaging
We acknowledge Michel Ovize from the Department of Cardiology, Louis Pradel Hospital, Lyon, France, for his help with this manuscript.
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