Document Detail


Prognostic value of a comprehensive cardiac magnetic resonance assessment soon after a first ST-segment elevation myocardial infarction.
MedLine Citation:
PMID:  19608133     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To evaluate the prognostic value of a comprehensive cardiac magnetic resonance (CMR) assessment soon after a first ST-segment elevation myocardial infarction (STEMI). BACKGROUND: CMR allows for a simultaneous assessment of wall motion abnormalities (WMA), WMA with low-dose dobutamine (WMA-dobutamine), microvascular obstruction, and transmural necrosis. This approach has been proven to be useful to predict late systolic recovery soon after STEMI. Its prognostic value and the relative prognostic weight of these indexes are not well-defined. METHODS: We studied 214 consecutive patients with a first STEMI treated with thrombolytic therapy or primary angioplasty discharged from hospital. In the first week (7 +/- 1 day after infarction), with CMR we determined the extent (number of segments) of WMA, WMA-dobutamine, microvascular obstruction, and transmural necrosis. RESULTS: During a median follow-up of 553 days, 21 major adverse cardiac events (MACE) including 4 cardiac deaths, 6 nonfatal myocardial infarctions, and 11 readmissions for heart failure were documented. The MACE was associated with a larger extent of WMA (8 +/- 4 segments vs. 5 +/- 3 segments, p < 0.001), WMA-dobutamine (6 +/- 4 segments vs. 4 +/- 3 segments, p = 0.004), microvascular obstruction (3 +/- 3 segments vs. 1 +/- 2 segments p <0.001), and transmural necrosis (7 +/- 3 segments vs. 3 +/- 3 segments, p < 0.001). In a complete multivariate analysis that included baseline characteristics, electrocardiogram, biomarkers, angiography, ejection fraction, left ventricular volumes, and all CMR indexes, WMA/segment (hazard ratio: 1.29 [95% confidence interval: 1.11 to 1.49], p = 0.001) and the extent of transmural necrosis/segment (hazard ratio: 1.30 [95% confidence interval: 1.12 to 1.51], p < 0.001) were the only independent prognostic variables. CONCLUSIONS: A comprehensive CMR assessment is useful for stratifying risk soon after STEMI, but only the extent of systolic dysfunction and of transmural necrosis provide independent prognostic information.
Authors:
Vicente Bodi; Juan Sanchis; Julio Nunez; Luis Mainar; Maria P Lopez-Lereu; Jose V Monmeneu; Eva Rumiz; Fabian Chaustre; Isabel Trapero; Oliver Husser; Maria J Forteza; Francisco J Chorro; Angel Llacer
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Publication Detail:
Type:  Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  JACC. Cardiovascular imaging     Volume:  2     ISSN:  1876-7591     ISO Abbreviation:  JACC Cardiovasc Imaging     Publication Date:  2009 Jul 
Date Detail:
Created Date:  2009-07-17     Completed Date:  2009-09-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101467978     Medline TA:  JACC Cardiovasc Imaging     Country:  United States    
Other Details:
Languages:  eng     Pagination:  835-42     Citation Subset:  IM    
Affiliation:
Cardiology Department, Hospital Clinico Universitario, Universidad de Valencia, Valencia, Spain. vicentbodi@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-Agonists / diagnostic use
Adult
Aged
Angioplasty, Transluminal, Percutaneous Coronary* / adverse effects,  mortality
Coronary Vessels / pathology
Dobutamine / diagnostic use
Female
Heart Failure / etiology,  mortality
Humans
Kaplan-Meiers Estimate
Magnetic Resonance Imaging, Cine*
Male
Microvessels / pathology
Middle Aged
Myocardial Contraction*
Myocardial Infarction / complications,  diagnosis*,  mortality,  physiopathology,  therapy
Myocardium / pathology*
Necrosis
Predictive Value of Tests
Prognosis
Proportional Hazards Models
Recurrence
Risk Assessment
Risk Factors
Thrombolytic Therapy* / adverse effects,  mortality
Time Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Adrenergic beta-Agonists; 34368-04-2/Dobutamine
Comments/Corrections
Comment In:
JACC Cardiovasc Imaging. 2009 Jul;2(7):843-5   [PMID:  19608134 ]

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


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