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European Radiology

, Volume 29, Issue 5, pp 2369–2377 | Cite as

Microvascular obstruction extent predicts major adverse cardiovascular events in patients with acute myocardial infarction and preserved ejection fraction

  • Nicola Galea
  • Gian Marco Dacquino
  • Rosa Maria Ammendola
  • Simona Coco
  • Luciano Agati
  • Laura De Luca
  • Iacopo Carbone
  • Francesco Fedele
  • Carlo Catalano
  • Marco FranconeEmail author
Cardiac

Abstract

Objectives

To investigate the prognostic role of early post-infarction cardiac magnetic resonance (CMR) on long-term risk stratification of ST segment elevation myocardial infarction (STEMI) patients with preserved left ventricular ejection fraction (LVEF).

Methods

Seventy-seven STEMI patients treated by primary percutaneous coronary intervention (PCI) and LVEF > 50% at CMR were included. The median time between STEMI and CMR was 5 days (IQR 2–8). LV volumes and function, area at risk (on T2 weighted images), infarcted myocardium (on late enhanced images), intramyocardial hemorrhage, and early and late microvascular obstruction (MVO) were detected and measured. CMR tissue determinants were correlated with the incidence of major adverse cardiovascular events (MACEs) over a 5-year follow-up.

Results

During median follow-up of 4 years (range 3 to 5 years), eight (10%) patients experienced MACE, yielding an annualized event rate of 2.1%. All CMR tissue markers were not significantly different between MACE and no-MACE patients, except for the presence of late MVO (50% vs. 16%, respectively; p = 0.044) and its extent (2.30 ± 1.64 g vs. 0.18 ± 0.12 g, respectively; p = 0.000). From receiver-operating characteristic (ROC) curve (area under the curve 0.89; 95% confidence interval, 0.75–1.0; p = 0.000), late MVO extent > 0.385 g was a strong independent predictor of MACE at long-term follow-up (sensitivity = 87%, specificity = 90%; hazard ratio = 2.24; 95% confidence interval, 1.51–3.33; p = 0.000).

Conclusions

Late MVO extent after primary PCI on CMR seems to be a strong predictor of MACE at 5-year follow-up in patients with LVEF > 50%. Noticeably, late MVO extent > 0.385 g provided relevant prognostic insights leading to improved long-term risk stratification.

Key Points

Tissue markers provided by cardiac magnetic resonance aid in prognostic stratification after myocardial infarction

The occurrence of late microvascular obstruction after acute myocardial infarction increases risk of major adverse events at 5-year follow-up.

The greater microvascular obstruction extent on late gadolinium enhanced images is related to an increased risk of adverse events in patients with myocardial infarction and preserved left ventricular function.

Keywords

Cardiac magnetic resonance Acute myocardial infarction Left ventricular ejection fraction Major adverse cardiovascular events Microvascular obstruction 

Abbreviations

AAR

Area at risk

ACE

Angiotensin converting enzyme

AMI

Acute myocardial infarction

ARB

Angiotensin receptor blocker

AUC

Area under the curve

CABG

Coronary artery bypass graft

CMR

Cardiac magnetic resonance

EDV

End-diastolic volume

ESV

End-systolic volume

HF

Heart failure

HFPEF

Heart failure with preserved ejection fraction

IQR

Interquartile range

LGE

Late gadolinium enhancement

LVEF

Left ventricular ejection fraction

LVSD

Left ventricular systolic dysfunction

MACE

Major adverse cardiovascular events

MVO

Microvascular obstruction

NSTEMI

Non ST segment elevation myocardial infarction

PCI

Percutaneous coronary intervention

ROC

Receiver-operating characteristic

RV

Right ventricle

STEMI

ST segment elevation myocardial infarction

STIR

Short tau inversion recovery

TE

Echo time

TI

Inversion time

TIMI

Thrombolysis in myocardial infarction

TR

Repetition time

TSE

Turbo spin echo

WMSI

Wall motion score index

Notes

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Marco Francone, MD PhD, EBCR.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from all patients in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• observational

• performed at one institution

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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Nicola Galea
    • 1
    • 2
  • Gian Marco Dacquino
    • 1
  • Rosa Maria Ammendola
    • 1
  • Simona Coco
    • 1
  • Luciano Agati
    • 3
  • Laura De Luca
    • 3
  • Iacopo Carbone
    • 1
  • Francesco Fedele
    • 3
  • Carlo Catalano
    • 1
  • Marco Francone
    • 1
    Email author
  1. 1.Department of Radiological, Oncological and Pathological SciencesSapienza University of Rome “Sapienza”RomeItaly
  2. 2.Department of Experimental MedicineUniversity of Rome “Sapienza”RomeItaly
  3. 3.Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric SciencesUniversity of Rome “Sapienza”RomeItaly

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