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The International Journal of Cardiovascular Imaging

, Volume 29, Issue 7, pp 1499–1509 | Cite as

Head-to-head comparison of 1 week versus 6 months CMR-derived infarct size for prediction of late events after STEMI

  • Oliver Husser
  • Jose V. Monmeneu
  • Clara Bonanad
  • Cristina Gomez
  • Fabian Chaustre
  • Julio Nunez
  • Maria P. Lopez-Lereu
  • Gema Minana
  • Juan Sanchis
  • Luis Mainar
  • Vicente Ruiz
  • Maria J. Forteza
  • Isabel Trapero
  • David Moratal
  • Francisco J. Chorro
  • Vicente Bodi
Original Paper

Abstract

Infarct size (IS) at 1 week after ST-elevation myocardial infarction (MI) diminishes during the first months. The incremental prognostic value of IS regression and of scar size (SS) at 6 months is unknown. We compared cardiovascular magnetic resonance (CMR)-derived IS at 1 week and SS at 6 months after MI for predicting late major adverse cardiac events (MACE). 250 patients underwent CMR at 1 week and 6 months after MI. IS and SS were determined as the extent of transmural late enhancement (in >50 % of wall thickness, ETLE). During 163 weeks, 23 late MACE (cardiac death, MI or readmission for heart failure after the 6 months CMR) occurred. Patients with MACE had a larger IS at 1 week (6 [4–9] vs. 3 [1–5], p < .0001) and a larger SS at 6 months (5 [2–6] vs. 3 [1–5], p = .005) than those without MACE. Late MACE rates in IS >median were higher at 1 week (14 vs. 4 %, p = .007) and in SS >median at 6 months (12 vs. 5 %, p = .053). The C-statistic for predicting late MACE of CMR at 1 week and 6 months was comparable (.720 vs. .746, p = .1). Only ETLE at 1 week (HR 1.31 95 % CI [1.14–1.52], p < .0001, per segment) independently predicted late MACE. CMR-derived SS at 6 months does not offer prognostic value beyond IS at 1 week after MI. The strongest predictor of late MACE is ETLE at 1 week.

Keywords

Cardiovascular magnetic resonance ST-elevation myocardial infarction Prognosis Late gadolinium enhancement imaging 

Notes

Acknowledgments

This work was supported by the “Instituto de Salud Carlos III” (PI1102323 grant). O. Husser was supported by the “Regensburger Forschungsförderung in der Medizin (ReForM)”.

Conflict of interest

No conflict of interest exists in the present study.

Supplementary material

10554_2013_239_MOESM1_ESM.ppt (92 kb)
Supplementary material 1 (PPT 92 kb)
10554_2013_239_MOESM2_ESM.docx (14 kb)
Supplementary material 2 (DOCX 14 kb)

References

  1. 1.
    Perazzolo Marra M, Lima JA, Iliceto S (2011) MRI in acute myocardial infarction. Eur Heart J 32:284–293. doi: 10.1093/eurheartj/ehq409 PubMedCrossRefGoogle Scholar
  2. 2.
    Hombach V, Merkle N, Kestler HA, Torzewski J, Kochs M et al (2008) Characterization of patients with acute chest pain using cardiac magnetic resonance imaging. Clin Res Cardiol 97:760–767PubMedCrossRefGoogle Scholar
  3. 3.
    Kim RJ, Wu E, Rafael A, Chen EL, Parker MA et al (2000) The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. N Engl J Med 343:1445–1453. doi: 10.1056/NEJM200011163432003 PubMedCrossRefGoogle Scholar
  4. 4.
    Bodí V, Husser O, Sanchis J, Núñez J, López-Lereu MP et al (2010) Contractile reserve and extent of transmural necrosis in the setting of myocardial stunning: comparison at cardiac MR imaging. Radiology 255:755–763. doi: 10.1148/radiol.10091191 PubMedCrossRefGoogle Scholar
  5. 5.
    Bodi V, Sanchis J, Nunez J, Mainar L, Lopez-Lereu MP et al (2009) Prognostic value of a comprehensive cardiac magnetic resonance assessment soon after a first ST-segment elevation myocardial infarction. JACC Cardiovasc Imaging 2:835–842. doi: 10.1016/j.jcmg.2009.03.011 PubMedCrossRefGoogle Scholar
  6. 6.
    Wu KC, Zerhouni EA, Judd RM, Lugo-Olivieri CH, Barouch LA et al (1998) Prognostic significance of microvascular obstruction by magnetic resonance imaging in patients with acute myocardial infarction. Circulation 97:765–772PubMedCrossRefGoogle Scholar
  7. 7.
    Hombach V, Grebe O, Merkle N, Waldenmaier S, Hoher M et al (2005) Sequelae of acute myocardial infarction regarding cardiac structure and function and their prognostic significance as assessed by magnetic resonance imaging. Eur Heart J 26:549–557PubMedCrossRefGoogle Scholar
  8. 8.
    de Waha S, Desch S, Eitel I, Fuernau G, Lurz P et al (2012) Relationship and prognostic value of microvascular obstruction and infarct size in ST-elevation myocardial infarction as visualized by magnetic resonance imaging. Clin Res Cardiol 101:487–495. doi: 10.1007/s00392-012-0419-3 PubMedCrossRefGoogle Scholar
  9. 9.
    Yan AT, Gibson CM, Larose E, Anavekar NS, Tsang S et al (2006) Characterization of microvascular dysfunction after acute myocardial infarction by cardiovascular magnetic resonance first-pass perfusion and late gadolinium enhancement imaging. J Cardiovasc Magn Reson 8:831–837. doi: 10.1080/10976640600778049 PubMedCrossRefGoogle Scholar
  10. 10.
    Ørn S, Manhenke C, Greve OJ, Larsen AI, Bonarjee VV et al (2009) Microvascular obstruction is a major determinant of infarct healing and subsequent left ventricular remodelling following primary percutaneous coronary intervention. Eur Heart J 30:1978–1985. doi: 10.1093/eurheartj/ehp219 PubMedCrossRefGoogle Scholar
  11. 11.
    Ingkanisorn WP, Rhoads KL, Aletras AH, Kellman P, Arai AE (2004) Gadolinium delayed enhancement cardiovascular magnetic resonance correlates with clinical measures of myocardial infarction. J Am Coll Cardiol 43:2253–2259. doi: 10.1016/j.jacc.2004.02.046 PubMedCrossRefGoogle Scholar
  12. 12.
    Fieno DS, Hillenbrand HB, Rehwald WG, Harris KR, Decker RS et al (2004) Infarct resorption, compensatory hypertrophy, and differing patterns of ventricular remodeling following myocardial infarctions of varying size. J Am Coll Cardiol 43:2124–2131. doi: 10.1016/j.jacc.2004.01.043 PubMedCrossRefGoogle Scholar
  13. 13.
    Mewton N, Liu CY, Croisille P, Bluemke D, Lima JA (2011) Assessment of myocardial fibrosis with cardiovascular magnetic resonance. J Am Coll Cardiol 57:891–903. doi: 10.1016/j.jacc.2010.11.013 PubMedCrossRefGoogle Scholar
  14. 14.
    van den Borne SW, Diez J, Blankesteijn WM, Verjans J, Hofstra L, Narula J (2010) Myocardial remodeling after infarction: the role of myofibroblasts. Nat Rev Cardiol 7:30–37. doi: 10.1038/nrcardio.2009.199 PubMedCrossRefGoogle Scholar
  15. 15.
    Henriques JP, Zijlstra F, van‘t Hof AW, de Boer MJ, Dambrink JH et al (2003) Angiographic assessment of reperfusion in acute myocardial infarction by myocardial blush grade. Circulation 107:2115–2119. doi: 10.1161/01.CIR.0000065221.06430.ED PubMedCrossRefGoogle Scholar
  16. 16.
    Bodi V, Sanchis J, Lopez-Lereu MP, Nunez J, Mainar L et al (2009) Prognostic and therapeutic implications of dipyridamole stress cardiovascular magnetic resonance on the basis of the ischaemic cascade. Heart 95:49–55. doi: 10.1136/hrt.2007.139683 PubMedCrossRefGoogle Scholar
  17. 17.
    Stehling MK, Holzknecht NG, Laub G, Böhm D, von Smekal A, Reiser M (1996) Single-shot T1- and T2-weighted magnetic resonance imaging of the heart with black blood: preliminary experience. MAGMA 4:231–240PubMedCrossRefGoogle Scholar
  18. 18.
    Simonetti OP, Finn JP, White RD, Laub G, Henry DA (1996) “Black blood” T2-weighted inversion-recovery MR imaging of the heart. Radiology 199:49–57PubMedGoogle Scholar
  19. 19.
    Abdel-Aty H, Boyé P, Zagrosek A, Wassmuth R, Kumar A et al (2005) Diagnostic performance of cardiovascular magnetic resonance in patients with suspected acute myocarditis: comparison of different approaches. J Am Coll Cardiol 45:1815–1822. doi: 10.1016/j.jacc.2004.11.069 PubMedCrossRefGoogle Scholar
  20. 20.
    Bodi V, Sanchis J, Lopez-Lereu MP, Nunez J, Mainar L et al (2007) Prognostic value of dipyridamole stress cardiovascular magnetic resonance imaging in patients with known or suspected coronary artery disease. J Am Coll Cardiol 50:1174–1179. doi: 10.1016/j.jacc.2007.06.016 PubMedCrossRefGoogle Scholar
  21. 21.
    Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S et al (2002) Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 105:539–542PubMedCrossRefGoogle Scholar
  22. 22.
    Husser O, Bodi V, Sanchis J, Nunez J, Lopez-Lereu MP et al (2011) Predictors of cardiovascular magnetic resonance-derived microvascular obstruction on patient admission in STEMI. Int J Cardiol. doi: 10.1016/j.ijcard.2011.09.083
  23. 23.
    Monmeneu JV, Bodi V, Sanchis J, Lopez-Lereu MP, Mainar L et al (2009) Cardiac magnetic resonance evaluation of edema after ST-elevation acute myocardial infarction. Rev Esp Cardiol 62:858–866PubMedCrossRefGoogle Scholar
  24. 24.
    Thygesen K, Alpert JS, White HD (2007) Universal definition of myocardial infarction. J Am Coll Cardiol 50:2173–2195PubMedCrossRefGoogle Scholar
  25. 25.
    Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJ, Ponikowski P et al (2008) ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J 29:2388–2442PubMedCrossRefGoogle Scholar
  26. 26.
    Saeed M, Lund G, Wendland MF, Bremerich J, Weinmann H, Higgins CB (2001) Magnetic resonance characterization of the peri-infarction zone of reperfused myocardial infarction with necrosis-specific and extracellular nonspecific contrast media. Circulation 103:871–876PubMedCrossRefGoogle Scholar
  27. 27.
    Nadal-Ginard B, Kajstura J, Leri A, Anversa P (2003) Myocyte death, growth, and regeneration in cardiac hypertrophy and failure. Circ Res 92:139–150PubMedCrossRefGoogle Scholar
  28. 28.
    Bodi V, Sanchis J, Lopez-Lereu MP, Losada A, Nunez J et al (2005) Usefulness of a comprehensive cardiovascular magnetic resonance imaging assessment for predicting recovery of left ventricular wall motion in the setting of myocardial stunning. J Am Coll Cardiol 46:1747–1752PubMedCrossRefGoogle Scholar
  29. 29.
    Wu E, Ortiz JT, Tejedor P, Lee DC, Bucciarelli-Ducci C et al (2008) Infarct size by contrast enhanced cardiac magnetic resonance is a stronger predictor of outcomes than left ventricular ejection fraction or end-systolic volume index: prospective cohort study. Heart 94:730–736PubMedCrossRefGoogle Scholar
  30. 30.
    Steg PG, James SK, Atar D, Badano LP, Blömstrom-Lundqvist C et al (2012) ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 33:2569–2619. doi: 10.1093/eurheartj/ehs215 PubMedCrossRefGoogle Scholar
  31. 31.
    Wu KC, Kim RJ, Bluemke DA, Rochitte CE, Zerhouni EA et al (1998) Quantification and time course of microvascular obstruction by contrast-enhanced echocardiography and magnetic resonance imaging following acute myocardial infarction and reperfusion. J Am Coll Cardiol 32:1756–1764PubMedCrossRefGoogle Scholar
  32. 32.
    Eitel I, Kubusch K, Strohm O, Desch S, Mikami Y et al (2011) Prognostic value and determinants of a hypointense infarct core in T2-weighted cardiac magnetic resonance in acute reperfused ST-elevation-myocardial infarction. Circ Cardiovasc Imaging 4:354–362PubMedCrossRefGoogle Scholar
  33. 33.
    Ganame J, Messalli G, Dymarkowski S, Rademakers FE, Desmet W et al (2009) Impact of myocardial haemorrhage on left ventricular function and remodelling in patients with reperfused acute myocardial infarction. Eur Heart J 30:1440–1449PubMedCrossRefGoogle Scholar
  34. 34.
    Carlsson M, Ubachs JF, Hedström E, Heiberg E, Jovinge S, Arheden H (2009) Myocardium at risk after acute infarction in humans on cardiac magnetic resonance: quantitative assessment during follow-up and validation with single-photon emission computed tomography. JACC Cardiovasc Imaging 2:569–576. doi: 10.1016/j.jcmg.2008.11.018 PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Oliver Husser
    • 1
    • 2
    • 3
  • Jose V. Monmeneu
    • 4
  • Clara Bonanad
    • 1
  • Cristina Gomez
    • 1
  • Fabian Chaustre
    • 1
    • 5
  • Julio Nunez
    • 1
  • Maria P. Lopez-Lereu
    • 4
  • Gema Minana
    • 1
  • Juan Sanchis
    • 1
  • Luis Mainar
    • 1
  • Vicente Ruiz
    • 1
  • Maria J. Forteza
    • 1
  • Isabel Trapero
    • 1
  • David Moratal
    • 5
  • Francisco J. Chorro
    • 1
  • Vicente Bodi
    • 1
  1. 1.Cardiology Department, Hospital Clinico Universitario, INCLIVAUniversidad de ValenciaValenciaSpain
  2. 2.Klinik und Poliklinik für Innere Medizin IIUniversity of Regensburg Medical CenterRegensburgGermany
  3. 3.Klinik für Herz- und KreislauferkrankungenDeutsches Herzzentrum MünchenMunichGermany
  4. 4.ERESAValenciaSpain
  5. 5.Centro de Biomateriales e Ingeniería TisularUniversidad Politécnica de ValenciaValenciaSpain

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