A comparison of infarct mass by cardiac magnetic resonance and real time myocardial perfusion echocardiography as predictors of major adverse cardiac events following reperfusion for ST elevation myocardial infarction

Abstract

Purpose: Infarct mass as assessed by myocardial-delayed enhancement imaging on cardiac magnetic resonance (CMR) and myocardial blood flow as assessed by real time myocardial perfusion echocardiography (RT-MPE) have been shown to predict adverse events following ST elevation myocardial infarction (STEMI). There has been no published comparison of quantitative assessment using these modalities as predictors of clinical outcomes to date. We compared RT-MPE with CMR for prediction of cardiac events in reperfused STEMI patients. Materials and Methods:Consecutive STEMI patients with early reperfusion were studied. RT-MPE and CMR were performed. Perfusion score indices (PSI RT-MPE and PSI CMR ) were calculated [sum of segmental perfusion scores/number of segments].CMR infarct mass (g) and RT-MPE myocardial blood flow (MBF dB/s) were quantified.Patients were followed for cardiac events (death, nonfatal MI, revascularization, angina, and heart failure).Results: All 27 patients (age 62±14; follow-up 3.5±2.6 years) had thrombolysis in myocardial infarction (TIMI) grade 3 flow of infarct vessel. Cardiac events occurred in 17 (63%). Cardiac event patients had higher PSI RT-MPE , PSI CMR , infarct mass, and lower MBF. PSI RT-MPE cutoff of 0.3 had an AUC of 0.856 (82% sensitivity, 70% specificity), while a PSI CMR cutoff of 0.2 had an AUC of 0.765 (76% sensitivity, 60% specificity).Infarct mass and MBF were independent predictors of cardiac events after adjusting for risk factors (hazard ratios: 20.9 [95% CI 1.8-256] P=. P=.01, respectively). Conclusions:Quantitative RT-MPE performed comparably to CMR for prediction of MACE in STEMI patients supporting a prognostic role for this noninvasive, bedside imaging method. K E Y W O R D Smajor adverse cardiac events, microvascular obstruction, outcomes research, perfusion imaging, prognosis, ST elevation myocardial infarction

Long-Term Prognostic Value of Myocardial Viability by Myocardial Contrast Echocardiography in Patients after Acute Myocardial Infarction: A Systematic Review and Meta-Analysis

“…A further 46 articles were excluded on full-text review for various reasons, including the absence of semiquantitative analysis or a lack of pre-specified outcomes. At last, six studies were eventually used for a detailed study [ 13 , 14 , 16 , 17 , 21 , 22 ]. A flowchart of our search results is presented in Figure 1 .…”

“…In these two studies, there were fewer patients who underwent PTCA or only received medical therapy; in comparison, the majority of patients underwent PTCA in the other four studies. Furthermore, all patients in the studies by Abdelmoneim et al [ 17 ] and Lenz et al [ 13 ] achieved TIMI flow 3 after PCI. Previous studies [ 34 , 35 , 36 , 37 ] show that PCI leads to excellent clinical outcomes and a continued decline in perioperative adverse events [ 38 ].…”

“…Studies [ 12 , 30 ] that compared MCE and SPECT in the same group demonstrated that MCE was superior to SPECT in predicting hard cardiac events or global recovery of function after AMI. Moreover, several studies [ 13 , 31 , 32 , 33 ] have shown that the performance of MCE was comparable to that of cardiac magnetic resonance imaging (CMR) in patients after AMI, and MCE had a comparable accuracy as a predictor of MACE in AMI patients. The 2017 European Association of Cardiovascular Imaging has already recommended MCE as a class IIA imaging method to improve MV evaluation [ 27 ].…”

“…A multicenter Acute Myocardial Infarction Contrast Imaging study demonstrated that, among patients with TIMI 3 flow after ST elevation myocardial infarction, the extent of microvascular damage assessed by MCE is the most powerful independent predictor of left ventricle remodeling compared to other established clinical and angiographic parameters of reperfusion [ 11 ]. Recently, several studies [ 12 , 13 , 14 , 15 , 16 , 17 ] have further explored the long-term prognostic significance of MCE in patients with AMI. However, the clinical significance of these studies has been limited by small sample sizes, single-center cohorts, and inconsistent results.…”

High versus Low Mechanical Index Imaging Diagnostic Ultrasound in Patients with Myocardial Infarction: A Therapeutic Application Study

“…Pre-percutaneous coronary interventions and post-percutaneous coronary interventions (at 48 hours before discharge from the hospital and at 1-month from baseline interventions) coronary angiographies were performed by interventional cardiologists (a minimum of 3-years of experiences) of institutes. Angiograms were analyzed according to thrombolysis in myocardial infarction (TIMI) flow grading [ 12 ] by interventional cardiologists (a minimum of 3-years of experiences) of institutes. TIMI flow grade 1 or 2 was considered as culprit vessels ( Figure 3 ).…”