Cardiac magnetic resonance imaging: infarct size is an independent predictor of mortality in patients with coronary artery disease

Bello, David; Einhorn, Arnold; Kaushal, Rishi; Kenchaiah, Satish; Raney, Aidan; Fieno, David S.; Narula, Jagat; Goldberger, Jeffrey J.; Shivkumar, Kalyanam; Subačius, Haris; Kadish, Alan H.

doi:10.1016/j.mri.2010.03.031

Cited by 61 publications

(47 citation statements)

References 43 publications

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“…49,66 Reduction of scar size is highly predictive of mortality, HF, and LV remodeling. 67,68 Cell therapies have been shown to reduce scar size significantly in a previous systematic review and meta-analysis in patients with acute myocardial infarction. 13 It is therefore tempting to suggest that in trials for HF, scar size could also be measured as a surrogate outcome to predict clinical efficacy.…”

Section: Discussionmentioning

confidence: 99%

Meta-Analysis of Cell Therapy Trials for Patients With Heart Failure

Fisher

Dorée

Mathur

et al. 2015

Circulation Research

190

158

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Rationale: Cell-based therapies are a promising intervention for the treatment of heart failure (HF) secondary to ischemic and nonischemic cardiomyopathy. However, the clinical efficacy of such new treatment requires further evaluation. Objective: To assess available clinical evidence on the safety and efficacy of cell-based therapies for HF. Methods and Results: Electronic databases (CENTRAL, DARE, NHSEED & HTA, PubMed, MEDLINE, EMBASE, CINAHL, LILACS, KoreaMed, PakMediNet, IndMed, and the Transfusion Evidence Library) were searched for relevant randomized controlled trials to June 2014. Trials of participants with HF and where the administration of any dose of autologous cells by any delivery route was compared with no intervention or placebo were eligible for inclusion. Primary outcomes were defined as mortality and rehospitalization as a result of HF. Secondary outcomes included performance status, quality of life, incidence of arrhythmias, brain natriuretic peptide levels, left ventricular ejection fraction, myocardial perfusion, and adverse events. Thirty-one independent trials (1521 participants) were included. The treatment significantly reduced the risk of mortality and rehospitalization caused by HF. There was a significant improvement in favor of stem cell treatment in performance status and exercise capacity, left ventricular ejection fraction, and quality of life. The treatment was also associated with a reduction of brain natriuretic peptide levels and no increase in the incidence of arrhythmias. However, there was considerable risk of performance, selection, and reporting bias among the included trials. Conclusions: This study shows evidence that autologous cell therapy may be beneficial for patients having HF, but further evidence is required.

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Section: Discussionmentioning

confidence: 99%

Meta-Analysis of Cell Therapy Trials for Patients With Heart Failure

Fisher

Dorée

Mathur

et al. 2015

Circulation Research

190

158

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“…These reports showed that extent of the left ventricular scarring as well as the extent of the peri-infarct zone were independent predictors of ventricular tachyarrhythmia induciblity in ischemic cardiomyopathy. Also these scar characteristics have been linked to appropriate ICD shocks in this patient group (6)(7)(8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 92%

No association between scar size and characteristics on T-wave alternans in post-myocardial infarction patients with relatively preserved ventricular function presented with nonsustained ventricular tachycardia

Yalın

Gölcük²,

Teker³

et al. 2014

Anadolu Kardiyol Derg

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Objective: Microvolt T-wave Alternans (TWA) is associated with abnormal repolarization and predicts arrhythmic mortality in patients with previous myocardial infarction (MI). Infarct tissue size and heterogeneity characterized by cardiac magnetic resonance (CMR) has been shown to be associated with arrhythmogenic substrates and sudden cardiac death. Although both delayed enhancement-CMR (de-CMR) and TWA are useful in risk stratification of post-MI patients with preserved left ventricular function, the relationship between scar size and TWA has not studied yet. In this study, we aimed to study the relation between TWA and scar size and characteristics assessed with CMR in post-MI patients (pts) with relatively preserved systolic function presented with nonsustained VT. Methods: This observational cross-sectional study was enrolled 36 post-MI patients with mild-systolic dysfunction and non-sustained ventricular tachycardia. Eight pts were excluded. Both TWA and contrast enhanced CMR were performed. Left ventricular ejection fraction (LVEF), dense scar, peri-infarct zone and total scar masses were assessed and these values to left ventricular (LV) mass ratios were calculated. Infarct ratios and characteristics were determined and compared among patients with negative TWA and those with positive TWA. Results: For the positive (n=12) vs. negative (n=16) TWA patients there were no significant difference between LVEF (44.9±5.4% vs. 44.0±3.2%, p=NS) and LV masses (121.89±26.56 g vs. 106.14±21.16 g, p=NS). The ratio of scar core to LV mass (3.37±0.68% vs. 3.31±1.01%, p=NS), peri-infarct zone to LV mass (23.61±7.93% vs. 21.64±9.08%, p=NS), total scar to LV mass (26.98±7.86% vs. 24.96±9.62%, p=NS) were all similar. Conclusion: There were no association between scar size and infarct heterogeneity and prevelance of TWA in post-MI patients with relatively preserved LVEF with non-sustained VT. Our data suggest that these two modalities may reflect different arrhythmogenic mechanisms in this cohort. (Anadolu Kardiyol Derg 2014; 14: 442-7)

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“…Particularly, there is interest in the assessment of volumetric change of the infarct and the peri-infarct tissue in the ventricular wall to monitor myocardial infarction (MI). This is based on recent studies that have shown that the infarct and peri-infarct zone is an independent predictor of post MI mortality [1,2]. Animal and human studies have demonstrated that this technique delineates infarct morphology with a high degree of correlation to infarct morphology by pathologic analysis [3].…”

Section: Introductionmentioning

confidence: 99%

“…Animal and human studies have demonstrated that this technique delineates infarct morphology with a high degree of correlation to infarct morphology by pathologic analysis [3]. Furthermore, cardiac MR performed in a prospective outcome study of 100 patients with coronary artery disease has shown that infarct mass is an independent predictor of mortality [4].…”

Section: Introductionmentioning

confidence: 99%

Segmentation of the Infarct and Peri-infarct Zones in Cardiac MR Images

Gupta

Shah

2010

Lecture Notes in Computer Science

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Abstract. This paper presents a novel approach for segmentation of the infarct and peri-infarct tissue in the left ventricular wall of the heart. This paper is motivated by a recent finding that shows the infarct and peri-infarct zones to be independent predictors of post myocardial infarction. This paper proposes a method to segment the endocardial and epicardial contours of the left ventricle in the presence of the enhanced infarct and peri-infarct tissues. A level set method using shape priors, obtained from a 3D active appearance model of the ventricle wall on cine MR images is presented. From the extracted 3D cardiac ventricular wall, a method is proposed to segment the infarct and peri-infarct tissues using intensity, volume, shape and heart wall thickness features. The parameters of end-diastolic volume, end-systolic volume, myocardial mass, ejection fraction and infarct and peri-infarct mass are computed using the proposed method and compared with the gold standard provided by the cardiologists. Promising results and comparisons demonstrate the potential of our approach for a practical computer assisted diagnostic system.

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Cardiac magnetic resonance imaging: infarct size is an independent predictor of mortality in patients with coronary artery disease

Cited by 61 publications

References 43 publications

Meta-Analysis of Cell Therapy Trials for Patients With Heart Failure

Meta-Analysis of Cell Therapy Trials for Patients With Heart Failure

No association between scar size and characteristics on T-wave alternans in post-myocardial infarction patients with relatively preserved ventricular function presented with nonsustained ventricular tachycardia

Segmentation of the Infarct and Peri-infarct Zones in Cardiac MR Images

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