Document Detail

Performance of angiographic, electrocardiographic and MRI methods to assess the area at risk in acute myocardial infarction.
MedLine Citation:
PMID:  21930725     Owner:  NLM     Status:  MEDLINE    
Objective Validation of methods to assess the area at risk (AAR) in patients with ST elevation myocardial infarction is limited. A study was undertaken to test different AAR methods using established physiological concepts to provide a reference standard. Main outcome measured In 78 reperfused patients with first ST elevation myocardial infarction, AAR was measured by electrocardiographic (Aldrich), angiographic (Bypass Angioplasty Revascularization Investigation (BARI), APPROACH) and cardiovascular magnetic resonance methods (T2-weighted hyperintensity and delayed enhanced endocardial surface area (ESA)). The following established physiological concepts were used to evaluate the AAR METHODS: (1) AAR size is always ≥ infarct size (IS); (2) in transmural infarcts AAR size=IS; (3) correlation between AAR size and IS increases as infarct transmurality increases; and (4) myocardial salvage ((AAR-IS)/AAR×100) is inversely related to infarct transmurality. Results Overall, 65%, 87%, 76%, 87% and 97% of patients using the Aldrich, BARI, APPROACH, T2-weighted hyperintensity and ESA methods obeyed the concept that AAR size is ≥IS. In patients with transmural infarcts (n=22), Bland-Altman analysis showed poor agreement (wide 95% limits of agreement) between AAR size and IS for the BARI, Aldrich and APPROACH methods (95% CI -22.9 to 29.6, 95% CI -28.3 to 21.3 and 95% CI -16.9 to 20.0, respectively) and better agreement for T2-weighted hyperintensity and ESA (95% CI -6.9 to 16.6 and 95% CI -4.3 to 18.0, respectively). Increasing correlation between AAR size and IS with increasing infarct transmurality was observed for the APPROACH, T2-weighted hyperintensity and ESA methods, with ESA having the highest correlation (r=0.93, p<0.001). The percentage of patients within a narrow margin (±30%) of the inverse line of identity between salvage extent and infarct transmurality was 56%, 76%, 65%, 77% and 92% for the Aldrich, BARI, APPROACH, T2-weighted hyperintensity and ESA methods, respectively, where higher percentages represent better concordance with the concept that the extent of salvage should be inversely related to infarct transmurality. Conclusions For measuring AAR, cardiovascular magnetic resonance methods are better than angiographic methods, which are better than electrocardiographic methods. Overall, ESA performed best for measuring AAR in vivo.
Mathijs O Versteylen; Sebastiaan C A M Bekkers; Martijn W Smulders; Bjorn Winkens; Casper Mihl; Mark H M Winkens; Tim Leiner; Johannes L Waltenberger; Raymond J Kim; Anton P M Gorgels
Related Documents :
7373825 - An electrographic study on the functional capacity of the coronary collateral circulati...
12238835 - An ovine model of postinfarction dilated cardiomyopathy.
2584555 - Technetium-99m isonitrile myocardial uptake at rest. i. relation to severity of coronar...
758745 - Coronary arteriography in acute transmural myocardial infarction.
23102905 - Differential membrane type 1 matrix metalloproteinase substrate processing with ischemi...
11872915 - Emergent use of anticoagulation for treatment of patients with ischemic stroke.
Publication Detail:
Type:  Journal Article; Validation Studies     Date:  2011-09-19
Journal Detail:
Title:  Heart (British Cardiac Society)     Volume:  98     ISSN:  1468-201X     ISO Abbreviation:  Heart     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2011-12-14     Completed Date:  2012-05-02     Revised Date:  2012-09-21    
Medline Journal Info:
Nlm Unique ID:  9602087     Medline TA:  Heart     Country:  England    
Other Details:
Languages:  eng     Pagination:  109-15     Citation Subset:  AIM; IM    
Department of Cardiology, Maastricht University Medical Center, P. Debyelaan 25, Maastricht, The Netherlands.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Magnetic Resonance Imaging*
Middle Aged
Myocardial Infarction / diagnosis*,  epidemiology*
Observer Variation
Risk Assessment
Risk Factors
Comment In:
Heart. 2012 Mar;98(5):348-50   [PMID:  22184100 ]
Heart. 2012 Aug;98(16):1257; author reply 1257-8   [PMID:  22649094 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Maintenance of sinus rhythm with an ablation strategy in patients with atrial fibrillation is associ...
Next Document:  Detection of miR-92a and miR-21 in stool samples as potential screening biomarkers for colorectal ca...