Assessment of Myocardial Infarction by Cardiac Magnetic Resonance Imaging and Long-Term Mortality

Abstract

BackgroundCardiac magnetic resonance imaging provides detailed anatomical information on infarction. However, few studies have investigated the association of these data with mortality after acute myocardial infarction.ObjectiveTo study the association between data regarding infarct size and anatomy, as obtained from cardiac magnetic resonance imaging after acute myocardial infarction, and long-term mortality.MethodsA total of 1959 reports of “infarct size” were identified in 7119 cardiac magnetic resonance imaging studies, of which 420 had clinical and laboratory confirmation of previous myocardial infarction. The variables studied were the classic risk factors – left ventricular ejection fraction, categorized ventricular function, and location of acute myocardial infarction. Infarct size and acute myocardial infarction extent and transmurality were analyzed alone and together, using the variable named “MET-AMI”. The statistical analysis was carried out using the elastic net regularization, with the Cox model and survival trees.ResultsThe mean age was 62.3 ± 12 years, and 77.3% were males. During the mean follow-up of 6.4 ± 2.9 years, there were 76 deaths (18.1%). Serum creatinine, diabetes mellitus and previous myocardial infarction were independently associated with mortality. Age was the main explanatory factor. The cardiac magnetic resonance imaging variables independently associated with mortality were transmurality of acute myocardial infarction (p = 0.047), ventricular dysfunction (p = 0.0005) and infarcted size (p = 0.0005); the latter was the main explanatory variable for ischemic heart disease death. The MET-AMI variable was the most strongly associated with risk of ischemic heart disease death (HR: 16.04; 95%CI: 2.64-97.5; p = 0.003).ConclusionThe anatomical data of infarction, obtained from cardiac magnetic resonance imaging after acute myocardial infarction, were independently associated with long-term mortality, especially for ischemic heart disease death.

Platelet Reactivity Was Not Associated with Infarct Size after Primary Percutaneous Coronary Intervention

“…Large infarct size increases the risk of symptomatic heart failure and cardiac death. 1 2 3 4 One study demonstrated that patients with an infarction >12% of the left ventricle showed a 7% mortality rate at 2 years, while those with an infarction <12% had 0% mortality. 5 Thus, optimizing the strategy to minimize infarct size is essential to STEMI management.…”

Prognostic value of divergent pattern detection by 99mTc-sestamibi gated SPECT in patients with anterior acute myocardial infarction

“…26 CMR protocols for studying LV morphology and function in patients with CAD also include the use of contrast media; late gadolinium enhancement (LGE) of the LV myocardium can be indicative of myocardial edema, non-viable tissue, and eventually of scar. 27,28 LV remodeling in patients undergoing CMR was identified by increased extent of LGE, 29 associated or not with low values of LVEF, 30 by significant reduction of the wall thickness, 28 by association between data regarding infarct size and cardiac anatomy, 31 and by assessment of myocardial perfusion changes. 31 We suggest that DP as well could be successfully and easily assessed by CMR, using appropriate images at mid-ventricular and at basal level, with the advantages of excellent spatial resolution, characterization of myocardial tissue and lack of ionizing radiation.…”

“…27,28 LV remodeling in patients undergoing CMR was identified by increased extent of LGE, 29 associated or not with low values of LVEF, 30 by significant reduction of the wall thickness, 28 by association between data regarding infarct size and cardiac anatomy, 31 and by assessment of myocardial perfusion changes. 31 We suggest that DP as well could be successfully and easily assessed by CMR, using appropriate images at mid-ventricular and at basal level, with the advantages of excellent spatial resolution, characterization of myocardial tissue and lack of ionizing radiation. 32 Together with the above-mentioned lack of methodological comparison with alternative imaging techniques, in particular echocardiography, the two most important limitations of this study are the small patient population and the short follow-up.…”

The impact of the location of a chronic total occlusion in a non-infarct-related artery on long-term mortality in ST-elevation myocardial infarction patients

“…As left ventricular function is related to cardiogenic shock, it could explain our finding that all prognostic significance of CTO or culprit location was lost after adding cardiogenic shock into the multivariate model. The importance of the anterior wall of the left ventricle on prognosis, which is for the most part dependent on the LAD for blood supply, has been well documented both in stable coronary artery disease and in patients with myocardial infarction [18][19][20] left ventricular ejection fraction (LVEF), caused by a larger final infarct size 19,[21][22][23][24][25][26] . In addition, the observed lower myocardial blush grade (MBG) in proximal LAD culprit lesions could be related to a larger infarct size, more oedema, higher filling pressures, and increased downstream microvascular resistance 27 .…”