Document Detail

Cardiac magnetic resonance with edema imaging identifies myocardium at risk and predicts worse outcome in patients with non-ST-segment elevation acute coronary syndrome.
MedLine Citation:
PMID:  20510215     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The aim of this study was to define the prevalence and significance of myocardial edema in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS).
BACKGROUND: Most patients with NSTE-ACS undergo angiography, yet not all have obstructive coronary artery disease (CAD) requiring revascularization. Identifying patients with myocardium at risk could enhance the effectiveness of an early invasive strategy. Cardiac magnetic resonance (CMR) can demonstrate edematous myocardium subjected to ischemia but has not been used to evaluate NSTE-ACS patients.
METHODS: One hundred consecutive patients with NSTE-ACS were prospectively enrolled to undergo 30-min CMR, including T2-weighted edema imaging and late gadolinium enhancement before coronary angiography. Clinical management including revascularization decision-making was performed without CMR results.
RESULTS: Of 88 adequate CMR studies, 57 (64.8%) showed myocardial edema. Obstructive CAD requiring revascularization was present in 87.7% of edema-positive patients versus 25.8% of edema-negative patients (p < 0.001). By multiple logistic regression analysis after adjusting for late gadolinium enhancement, perfusion, and wall motion scores, TIMI risk score was not predictive of obstructive CAD. Conversely, an increase in T2 score by 1 U increased the odds of subsequent coronary revascularization by 5.70 times (95% confidence interval: 2.38 to 13.62, p < 0.001). Adjusting for peak troponin-I, patients with edema showed a higher hazard of a cardiovascular event or death within 6 months after NSTE-ACS compared with those without edema (hazard ratio: 4.47, 95% confidence interval: 1.00 to 20.03; p = 0.050).
CONCLUSIONS: In NSTE-ACS patients, rapid CMR identifies reversibly injured myocardium due to obstructive CAD and predicts worse outcomes. Identifying myocardium at risk may help direct appropriate patients toward early invasive management.
Subha V Raman; Orlando P Simonetti; Marshall W Winner; Jennifer A Dickerson; Xin He; Ernest L Mazzaferri; Giuseppe Ambrosio
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  55     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-05-31     Completed Date:  2010-06-15     Revised Date:  2013-06-12    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2480-8     Citation Subset:  AIM; IM    
Ohio State University, Columbus, Ohio 43210, USA.
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MeSH Terms
Acute Coronary Syndrome / diagnosis*,  mortality*,  therapy
Angioplasty, Balloon, Coronary / methods
Cohort Studies
Coronary Angiography / methods
Edema / diagnosis*,  mortality*,  therapy
Follow-Up Studies
Gadolinium / diagnostic use
Image Enhancement
Magnetic Resonance Imaging / methods*
Middle Aged
Myocardium / pathology
Platelet Aggregation Inhibitors / therapeutic use
Predictive Value of Tests
Proportional Hazards Models
Prospective Studies
Risk Assessment
Severity of Illness Index
Survival Analysis
Treatment Outcome
Grant Support
Reg. No./Substance:
0/Platelet Aggregation Inhibitors; 7440-54-2/Gadolinium
Comment In:
J Am Coll Cardiol. 2010 Jun 1;55(22):2489-90   [PMID:  20510216 ]

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