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- Title
A comparison of infarct mass by cardiac magnetic resonance and real time myocardial perfusion echocardiography as predictors of major adverse cardiac events following reperfusion for ST elevation myocardial infarction.
- Authors
Lenz, Charles J; Abdelmoneim, Sahar S; Anavekar, Nandan S; Foley, Thomas A; Nhola, Lara F; Huang, Runqing; Oh, Jae K; Mulvagh, Sharon L
- Abstract
Purpose Infarct mass as assessed by myocardial-delayed enhancement imaging on cardiac magnetic resonance ( CMR) and myocardial blood flow as assessed by real time myocardial perfusion echocardiography ( RT- MPE) have been shown to predict adverse events following ST elevation myocardial infarction ( STEMI). There has been no published comparison of quantitative assessment using these modalities as predictors of clinical outcomes to date. We compared RT- MPE with CMR for prediction of cardiac events in reperfused STEMI patients. Materials and Methods Consecutive STEMI patients with early reperfusion were studied. RT- MPE and CMR were performed. Perfusion score indices ( PSIRT-MPE and PSICMR) were calculated [sum of segmental perfusion scores/number of segments]. CMR infarct mass (g) and RT- MPE myocardial blood flow ( MBF dB/s) were quantified. Patients were followed for cardiac events (death, nonfatal MI, revascularization, angina, and heart failure). Results All 27 patients (age 62±14; follow-up 3.5±2.6 years) had thrombolysis in myocardial infarction ( TIMI) grade 3 flow of infarct vessel. Cardiac events occurred in 17 (63%). Cardiac event patients had higher PSIRT-MPE, PSICMR, infarct mass, and lower MBF. PSIRT-MPE cutoff of 0.3 had an AUC of 0.856 (82% sensitivity, 70% specificity), while a PSICMR cutoff of 0.2 had an AUC of 0.765 (76% sensitivity, 60% specificity). Infarct mass and MBF were independent predictors of cardiac events after adjusting for risk factors (hazard ratios: 20.9 [95% CI 1.8-256] P=.02 and 8.1 [95% CI 1.5-78] P=.01, respectively). Conclusions Quantitative RT- MPE performed comparably to CMR for prediction of MACE in STEMI patients supporting a prognostic role for this noninvasive, bedside imaging method.
- Subjects
MYOCARDIAL infarction complications; COMPARATIVE studies; CONFIDENCE intervals; DIAGNOSTIC imaging; ECHOCARDIOGRAPHY; MAGNETIC resonance imaging; COMPUTERS in medicine; MYOCARDIAL reperfusion; MYOCARDIUM; PROBABILITY theory; PROGNOSIS; RECEIVER operating characteristic curves; CARDIAC-gated imaging
- Publication
Echocardiography, 2016, Vol 33, Issue 10, p1539
- ISSN
0742-2822
- Publication type
Article
- DOI
10.1111/echo.13308