Abstract
BackgroundLarge myocardial infarction (MI) is associated with adverse left ventricular (LV) remodeling (LVR). We studied the nature of LVR, with specific attention to non-transmural MIs, and the association of peak CK-MB with recovery and chronic phase scar size and LVR.MethodsAltogether 41 patients underwent prospectively repeated cardiovascular magnetic resonance at a median of 22 (interquartile range 9–29) days and 10 (8–16) months after the first revascularized MI. Transmural MI was defined as ≥75% enhancement in at least one myocardial segment.ResultsPeak CK-MB was 86 (40–216) μg/L in median, while recovery and chronic phase scar size were 13 (3–23) % and 8 (2–19) %. Altogether 33 patients (81%) had a non-transmural MI. Peak CK-MB had a strong correlation with recovery and chronic scar size (r ≥ 0.80 for all, r ≥ 0.74 for non-transmural MIs; p < 0.001). Peak CK-MB, recovery scar size, and chronic scar size, were all strongly correlated with chronic wall motion abnormality index (WMAi) (r ≥ 0.75 for all, r ≥ 0.73 for non-transmural MIs; p < 0.001). There was proportional scar size and LV mass resorption of 26% (0–50%) and 6% (− 2–14%) in median. Young age (< 60 years, median) was associated with greater LV mass resorption (median 9%vs.1%, p = 0.007).ConclusionsPeak CK-MB has a strong association with chronic scar size and wall motion abnormalities after revascularized non-transmural MI. Considerable infarct resorption happens after the first-month recovery phase. LV mass resorption is related to age, being more common in younger patients.
Highlights
Large myocardial infarction (MI) is associated with adverse left ventricular (LV) remodeling (LVR)
Thirty-five (85%) patients were treated with percutaneous coronary intervention (PCI), four (10%) with Coronary artery bypass craft (CABG) and 2 (5%) with thrombolysis only
Peak Creatine kinase MB (CK-MB), recovery and chronic scar size Before the era of acute coronary reperfusion, it was shown that the peak value of serially sampled CK-MB after acute MI significantly correlates with scar size at autopsy [16]
Summary
Large myocardial infarction (MI) is associated with adverse left ventricular (LV) remodeling (LVR). We studied the nature of LVR, with specific attention to non-transmural MIs, and the association of peak CK-MB with recovery and chronic phase scar size and LVR. Most past studies have focused on large MIs and subsequent global LV remodeling, and it has been presented that remodeling rarely occurs with infarct size less than 18.5% of LV volume [8]. The course of LV remodeling after smaller non-transmural MIs is less well established and there is still a lack of prospective studies with repeated comprehensive cardiovascular magnetic resonance (CMR) imaging. The preferred biomarkers of cardiac necrosis after MI are troponins due to high clinical sensitivity and myocardial tissue specificity, and CK-MB is the best alternative [10]. Troponins and CK-MB have all showed good correlation with infarct size and global ejection fraction after large reperfused MI, the relation between biomarkers and infarct size might be less robust in smaller infarcts [11]
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