Abstract
BackgroundClinical outcome following acute myocardial infarction is predicted by final infarct size evaluated in relation to left ventricular myocardium at risk (MaR). Contrast-enhanced steady-state free precession (CE-SSFP) cardiovascular magnetic resonance imaging (CMR) is not widely used for assessing MaR. Evidence of its utility compared to traditional assessment methods and as a surrogate for clinical outcome is needed.MethodsRetrospective analysis within a study evaluating post-conditioning during ST elevation myocardial infarction (STEMI) treated with coronary intervention (n = 78). CE-SSFP post-infarction was compared with angiographic jeopardy methods. Differences and variability between CMR and angiographic methods using Bland-Altman analyses were evaluated. Clinical outcomes were compared to MaR and extent of infarction.ResultsMaR showed correlation between CE-SSFP, and both BARI and APPROACH scores of 0.83 (p < 0.0001) and 0.84 (p < 0.0001) respectively. Bias between CE-SSFP and BARI was 1.1% (agreement limits -11.4 to +9.1). Bias between CE-SSFP and APPROACH was 1.2% (agreement limits -13 to +10.5). Inter-observer variability for the BARI score was 0.56 ± 2.9; 0.42 ± 2.1 for the APPROACH score; -1.4 ± 3.1% for CE-SSFP. Intra-observer variability was 0.15 ± 1.85 for the BARI score; for the APPROACH score 0.19 ± 1.6; and for CE-SSFP -0.58 ± 2.9%.ConclusionQuantification of MaR with CE-SSFP imaging following STEMI shows high correlation and low bias compared with angiographic scoring and supports its use as a reliable and practical method to determine myocardial salvage in this patient population.Trial registrationClinical trial registration information for the parent clinical trial:Karolinska Clinical Trial Registration (2008)Unique identifier: CT20080014. Registered 04th January 2008
Highlights
Clinical outcome following acute myocardial infarction is predicted by final infarct size evaluated in relation to left ventricular myocardium at risk (MaR)
It is of interest that several studies have demonstrated that cardiovascular magnetic resonance imaging (CMR) is equivalent to single photon emission computed tomography (SPECT) at 7 days following segment elevation myocardial infarction (STEMI) for assessing MaR using contrastenhanced steady-state free precession cardiac magnetic resonance (CE-SSFP), or T2-weighted sequences in a single examination [4, 7,8,9]
This study was a single-center single-blinded prospective clinical trial evaluating the benefit of intracoronary balloon–mediated ischemic post-conditioning on myocardial infarct size in patients presenting with STEMI the setting of a primary percutaneous coronary intervention service with study recruitment between 1st January 2009-31st December 2009 and has been described in detail previously [14]
Summary
Clinical outcome following acute myocardial infarction is predicted by final infarct size evaluated in relation to left ventricular myocardium at risk (MaR). The clinical outcome following acute ST-segment elevation myocardial infarction (STEMI) is predicted by the final infarct size [1, 2] This in turn is determined by a complex interplay between several factors including the duration of myocardial ischemia, the presence of collateral blood supply, reperfusion injury and left ventricular myocardium at risk (MaR). The reference technique for assessing the MaR is nuclear single photon emission computed tomography (SPECT) [4,5,6] This imaging modality, is not practical in the clinical setting as it requires acute imaging when a patient may remain clinically unstable as well as two subsequent image acquisitions. It is of interest that several studies have demonstrated that cardiovascular magnetic resonance imaging (CMR) is equivalent to SPECT at 7 days following STEMI for assessing MaR using contrastenhanced steady-state free precession cardiac magnetic resonance (CE-SSFP), or T2-weighted sequences in a single examination [4, 7,8,9]
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