Document Detail

Myocardium at risk in ST-segment elevation myocardial infarction comparison of T2-weighted edema imaging with the MR-assessed endocardial surface area and validation against angiographic scoring.
MedLine Citation:
PMID:  21920334     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The objective of this study was to assess the area at risk (AAR) in ST-segment elevation myocardial infarction with 2 different cardiac magnetic resonance (CMR) imaging methods and to compare them with the validated angiographic Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease Score (APPROACH-score) in a large consecutive patient cohort.
BACKGROUND: Edema imaging with T(2)-weighted CMR and the endocardial surface area (ESA) assessed by late gadolinium enhancement have been introduced as relatively new methods for AAR assessment in ST-segment elevation myocardial infarction. However, data on the utility and validation of these techniques are limited.
METHODS: A total of 197 patients undergoing primary percutaneous coronary intervention in acute ST-segment elevation myocardial infarction were included. AAR (assessed with T(2)-weighted edema imaging and the ESA method), infarct size, and myocardial salvage (AAR minus infarct size) were determined by CMR 2 to 4 days after primary angioplasty. Angiographic AAR scoring was performed by use of the APPROACH-score. All measurements were done offline by blinded observers.
RESULTS: The AAR assessed by T(2)-weighted imaging showed good correlation with the angiographic AAR (r = 0.87; p < 0.001), whereas the ESA showed only a moderate correlation either to T(2)-weighted imaging (r = 0.56; p < 0.001) or the APPROACH-score (r = 0.44; p < 0.001). Mean AAR by ESA (20.0 ± 11.7% of left ventricular mass) was significantly (p < 0.001) smaller than the AAR assessed by T(2)-weighted imaging (35.6 ± 10.9% of left ventricular mass) or the APPROACH-score (27.9 ± 10.5% of left ventricular mass) and showed a significant negative dependence on myocardial salvage index. In contrast, no dependence of T(2)-weighted edema imaging or the APPROACH-score on myocardial salvage index was seen.
CONCLUSIONS: The AAR can be reliably assessed by T(2)-weighted CMR, whereas assessment of the AAR by ESA seems to be dependent on the degree of myocardial salvage, thereby underestimating the AAR in patients with high myocardial salvage such as aborted infarction. Thus, assessment of the AAR with the ESA method cannot be recommended. (Myocardial Salvage and Contrast Dye Induced Nephropathy Reduction by N-Acetylcystein [LIPSIA-N-ACC]; NCT00463749).
Georg Fuernau; Ingo Eitel; Vinzenz Franke; Lysann Hildebrandt; Josefine Meissner; Suzanne de Waha; Philipp Lurz; Matthias Gutberlet; Steffen Desch; Gerhard Schuler; Holger Thiele
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article    
Journal Detail:
Title:  JACC. Cardiovascular imaging     Volume:  4     ISSN:  1876-7591     ISO Abbreviation:  JACC Cardiovasc Imaging     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-09-16     Completed Date:  2012-01-16     Revised Date:  2012-03-27    
Medline Journal Info:
Nlm Unique ID:  101467978     Medline TA:  JACC Cardiovasc Imaging     Country:  United States    
Other Details:
Languages:  eng     Pagination:  967-76     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Department of Internal Medicine/Cardiology, University of Leipzig -Heart Center, Leipzig, Germany.
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MeSH Terms
Angioplasty, Balloon, Coronary
Contrast Media / diagnostic use
Coronary Angiography*
Edema, Cardiac / diagnosis*,  pathology,  radiography
Magnetic Resonance Imaging*
Middle Aged
Myocardial Infarction / diagnosis*,  pathology,  radiography,  therapy
Myocardium / pathology*
Organometallic Compounds / diagnostic use
Predictive Value of Tests
Prospective Studies
Reproducibility of Results
Risk Assessment
Risk Factors
Treatment Outcome
Reg. No./Substance:
0/Contrast Media; 0/Organometallic Compounds; 138071-82-6/gadobutrol
Comment In:
JACC Cardiovasc Imaging. 2012 Feb;5(2):233-4; author reply 234-6   [PMID:  22340835 ]

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