| Contractile reserve and extent of transmural necrosis in the setting of myocardial stunning: comparison at cardiac MR imaging. | |
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MedLine Citation:
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PMID: 20392984 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2010-04-14 |
Journal Detail:
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Title: Radiology Volume: 255 ISSN: 1527-1315 ISO Abbreviation: Radiology Publication Date: 2010 Jun |
Date Detail:
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Created Date: 2010-05-26 Completed Date: 2010-07-15 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0401260 Medline TA: Radiology Country: United States |
Other Details:
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Languages: eng Pagination: 755-63 Citation Subset: AIM; IM |
Copyright Information:
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Copyright RSNA, 2010 |
Affiliation:
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Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, Blasco Ibáñez 17, 46010 Valencia, Spain. vicentbodi@hotmail.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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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:
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0/Cardiotonic Agents; 0/Contrast Media; 34368-04-2/Dobutamine; 80529-93-7/Gadolinium DTPA |
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