Long-Term Incremental Prognostic Value of Cardiovascular Magnetic Resonance After ST-Segment Elevation Myocardial Infarction

Symons, Rolf; Pontone, Gianluca; Schwitter, Juerg; Francone, Marco; Iglesias, Juan F.; Barison, Andrea; Zalewski, J; Luca, Laura De; Degrauwe, Sophie; Claus, Piet; Guglielmo, Marco; Nessler, Jadwiga; Carbone, Iacopo; Ferro, G; Durak, Monika; Magistrelli, Paolo; Presti, Alfonso Lo; Aquaro, Giovanni Donato; Eeckhout, Éric; Roguelov, Christan; Andreini, Daniele; Vogt, Pierre; Guaricci, Andrea Igoren; Mushtaq, Saima; Lorenzoni, Valentina; Müller, Olivier; Desmet, Walter; Agati, Luciano; Janssens, Stefan; Bogaert, Jan; Masci, Pier Giorgio

doi:10.1016/j.jcmg.2017.05.023

Cited by 83 publications

(61 citation statements)

References 33 publications

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“…Similar findings were reported from a multicenter registry including 810 revascularized STEMI patients [97]. MVO was associated with MACE in all multivariate models irrespective of whether it was entered as a dichotomous, continuous, or optimal cutoff variable [97]. In contrast, IS lost its prognostic relevance when corrected for MVO once again [97].…”

Section: Microvascular Injurysupporting

confidence: 80%

“…Regenfus et al showed that the extent of MVO was the strongest prognostic factor for six-year MACE rates in 245 STEMI patients [96]. Similar findings were reported from a multicenter registry including 810 revascularized STEMI patients [97]. MVO was associated with MACE in all multivariate models irrespective of whether it was entered as a dichotomous, continuous, or optimal cutoff variable [97].…”

Section: Microvascular Injurysupporting

confidence: 53%

“…At LGE, MVO is defined as a hypointense infarct core (dark) surrounded by the hyperintense infarct area (white). Most studies looking at the prognostic value of MVO after STEMI performed CMR between Days 3 and 7 after reperfusion therapy [24,[94][95][96][97][98]. Although additional research focusing on the optimal post-STEMI timing for CMR performance is clearly needed, there is consensus that the above-mentioned time window seems most appropriate for comprehensive myocardial tissue characterization (including MVO assessment) by CMR after STEMI [54].…”

Section: Microvascular Injurymentioning

confidence: 99%

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Role of Cardiac Magnetic Resonance to Improve Risk Prediction following Acute ST-elevation Myocardial Infarction

Reindl

Eitel

Reinstadler

2020

JCM

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Cardiac magnetic resonance (CMR) imaging allows comprehensive assessment of myocardial function and tissue characterization in a single examination after acute ST-elevation myocardial infarction. Markers of myocardial infarct severity determined by CMR imaging, especially infarct size and microvascular obstruction, strongly predict recurrent cardiovascular events and mortality. The prognostic information provided by a comprehensive CMR analysis is incremental to conventional risk factors including left ventricular ejection fraction. As such, CMR parameters of myocardial tissue damage are increasingly recognized for optimized risk stratification to further ameliorate the burden of recurrent cardiovascular events in this population. In this review, we provide an overview of the current impact of CMR imaging on optimized risk assessment soon after acute ST-elevation myocardial infarction.

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Section: Microvascular Injurysupporting

confidence: 80%

Section: Microvascular Injurysupporting

confidence: 53%

Section: Microvascular Injurymentioning

confidence: 99%

See 1 more Smart Citation

Role of Cardiac Magnetic Resonance to Improve Risk Prediction following Acute ST-elevation Myocardial Infarction

Reindl

Eitel

Reinstadler

2020

JCM

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“…There was a graded reduction in event-free survival in patients with MI size <25% of the LV, with and without microvascular obstruction, and those with MI size >25% of the LV, with and without microvascular obstruction. The prognostic value of microvascular obstruction over MI size for mortality and hospitalization for heart failure was recently confirmed by de Waha and colleagues 51 in a pooled analysis of patient-level data from 7 randomized controlled trials (n=1688) at 1 year and by Symons and colleagues 62 in a longitudinal study of 810 patients following a median follow-up of 5.5 years.…”

Section: Recent Advances In the Role Of Cmr In Reperfused Stemi Patientsmentioning

confidence: 83%

Cardiovascular Magnetic Resonance in Acute ST-Segment–Elevation Myocardial Infarction

et al. 2018

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While mortality following ST-segment elevation myocardial infarction (STEMI) is on the decline, the number of patients developing heart failure due to prior myocardial infarction (MI) is on the rise. Apart from timely reperfusion by primary percutaneous coronary intervention (PPCI), there is currently no established therapy for reducing MI size. As such new cardioprotective therapies are required to improve clinical outcomes following STEMI. Cardiovascular magnetic resonance (CMR) has emerged as an important imaging modality for assessing the efficacy of novel therapies for reducing MI size and preventing subsequent adverse left ventricular remodeling. The recent availability of multi-parametric mapping CMR has provided new insights into the pathophysiology underlying myocardial edema, microvascular obstruction, intramyocardial hemorrhage, and changes in the remote myocardial interstitial space following STEMI. In this article, we provide an overview of the recent advances in CMR imaging in reperfused STEMI patients, discuss the controversies surrounding its use, and explore future applications of CMR in this setting.

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“…Symons et al demonstrated that early post-infarction CMR-based MVO was a strong independent predictor of MACE in reperfused STEMI patients at long-term follow-up. Remarkably, MVO extent ≥2.6% of LV was the strongest independent predictor of death and heart failure hospitalization, overriding the prognostic performance of traditional outcome predictors and leading to better long-term risk stratification [39].…”

Section: Cardiac Magnetic Resonancementioning

confidence: 95%

A Handbook of Primary PCI: No-Reflow Management

Adjedj

Müller

Eeckhout

2018

Primary Angioplasty

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Although substantial progress has been made in recent decades in reducing mortality and performing optimal revascularization in patients with acute coronary syndrome (ACS) and stable coronary artery disease (CAD), one of the remaining challenges is to better prevent and treat extended myocardial damage despite "apparent" angiographic optimal percutaneous coronary intervention (PCI). The presence of no-reflow is related to higher risk of major adverse cardiac events (MACE) due to the poor healing of the infarct, adverse left ventricular remodelling, congestive heart failure occurrence and death. Despite optimal epicardial coronary artery reperfusion performed by PCI, distal microembolization into the coronary microcirculation limits myocardial salvage especially during ACS. No-reflow represents the ultimate stage of extended myocardial damage after PCI with absence of contrast medium progression in the coronary artery. This complication occurs mainly during ACS or during PCI of rotational atherectomy and venous graft in stable patients. The objective of this chapter is to describe how to manage a noreflow phenomenon from the pathophysiology to the management in order to help physician to prevent this complication and if no-reflow occurs adapt therapeutics to limit myocardial damage and reduce poor outcomes. DefinitionThe no-reflow phenomenon is defined as inadequate myocardial perfusion through a given segment of the coronary circulation without angiographic evidence of mechanical obstruction [1].

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Long-Term Incremental Prognostic Value of Cardiovascular Magnetic Resonance After ST-Segment Elevation Myocardial Infarction

Abstract: Early post-infarction CMR-based MVO is a strong independent prognosticator in revascularized STEMI patients. Remarkably, MVO extent ≥2.6% of LV improved long-term risk stratification over traditional outcome predictors.

Cited by 83 publications

References 33 publications

Role of Cardiac Magnetic Resonance to Improve Risk Prediction following Acute ST-elevation Myocardial Infarction

Role of Cardiac Magnetic Resonance to Improve Risk Prediction following Acute ST-elevation Myocardial Infarction

Cardiovascular Magnetic Resonance in Acute ST-Segment–Elevation Myocardial Infarction

A Handbook of Primary PCI: No-Reflow Management

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