Document Detail


Contractile reserve and extent of transmural necrosis in the setting of myocardial stunning: comparison at cardiac MR imaging.
MedLine Citation:
PMID:  20392984     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To perform a comparison of cardiac magnetic resonance (MR) imaging-derived ejection fraction (EF) during low-dose dobutamine infusion (EF(D)) with the extent of segments with transmural necrosis in more than 50% of their wall thickness (ETN) for the prediction of major adverse cardiac events (MACEs) and late systolic recovery soon after a first ST-segment elevation myocardial infarction (STEMI). MATERIALS AND METHODS: Institutional ethics committee approval and written informed consent were obtained. One hundred nineteen consecutive patients with a first STEMI, a depressed left ventricular EF, and an open infarct-related artery underwent MR imaging at 1 week after infarction. EF(D) and ETN (by using a 17-segment model) were determined, and the prediction of MACEs and systolic recovery at follow-up was assessed by using area under the receiver operating characteristic curve (AUC) and multivariable regression analysis. RESULTS: During follow-up (median, 613 days; range, 312-1243 days), 18 MACEs (five cardiac deaths, six myocardial infarctions, seven readmissions for heart failure) occurred. MACEs were associated with a lower EF(D) (43% +/- 12 [standard deviation] vs 49% +/- 10, P = .02) and a larger ETN (seven segments +/- three vs four segments +/- three, P < .001). Patients with systolic recovery (increase in EF of >5% at follow-up compared with baseline EF, n = 44) displayed a higher EF(D) (51% +/- 10 vs 47% +/- 9, P = .04) and a smaller ETN (three segments +/- two vs five segments +/- three, P = .002) at 1 week. ETN and EF(D) both related to MACEs (AUC: 0.78 vs 0.67, respectively, P = .1) and systolic recovery (AUC: 0.68 vs 0.62, respectively, P = .3). According to multivariable analysis, ETN was the only MR variable associated with time to MACEs (hazard ratio, 1.38; 95% confidence interval: 1.19, 1.60; P < .001) and systolic recovery (odds ratio, 0.76; 95% confidence interval: 0.64, 0.92; P = .004) independent of baseline characteristics. CONCLUSION: ETN is as useful as EF(D) for the prediction of MACEs and systolic recovery soon after STEMI.
Authors:
Vicente Bodí; Oliver Husser; Juan Sanchis; Julio Núñez; María P López-Lereu; José V Monmeneu; Luis Mainar; Fabian Chaustre; Günter A J Riegger; María J Bosch; Francisco J Chorro; Angel Llácer
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-04-14
Journal Detail:
Title:  Radiology     Volume:  255     ISSN:  1527-1315     ISO Abbreviation:  Radiology     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-05-26     Completed Date:  2010-07-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0401260     Medline TA:  Radiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  755-63     Citation Subset:  AIM; IM    
Copyright Information:
Copyright RSNA, 2010
Affiliation:
Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, Blasco Ibáñez 17, 46010 Valencia, Spain. vicentbodi@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
Angioplasty
Area Under Curve
Cardiotonic Agents / administration & dosage
Chi-Square Distribution
Contrast Media
Dobutamine / administration & dosage
Female
Gadolinium DTPA / diagnostic use
Heart Catheterization
Humans
Magnetic Resonance Imaging, Cine / methods*
Male
Middle Aged
Myocardial Contraction / physiology
Myocardial Infarction / pathology*,  physiopathology,  therapy
Myocardial Stunning / pathology*,  physiopathology,  therapy
Necrosis
Prospective Studies
Regression Analysis
Retreatment
Stents
Chemical
Reg. No./Substance:
0/Cardiotonic Agents; 0/Contrast Media; 34368-04-2/Dobutamine; 80529-93-7/Gadolinium DTPA

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