Predicting late myocardial recovery and outcomes in the early hours of ST-elevation myocardial infarction: traditional measures compared to microvascular perfusion, salvaged myocardium, and necrosis by cardiovascular magnetic resonance

Larose, Éric; Rodés‐Cabau, Josep; Rinfret, Stéphane; Proulx, Guy; Déry, Jean‐Pierre; Gleeton, Onil; Roy, Louis; Noël, Bernard; Barbeau, Gérald; Rouleau, Jacques R.; Boudreault, Jean-Roch; Amyot, Marc; Larochellière, Robert De; Bertrand, Olivier

doi:10.1186/1532-429x-12-s1-o77

Cited by 58 publications

(75 citation statements)

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“…Interobserver agreement was better with bright-blood T2-weighted MRI than dark-blood STIR. Because quantitative assessment of the ischemic area at risk and myocardial salvage have emerging importance for clinical and research purposes, [3][4][5][6][7][8][9][10][11][12][13][14][15] our results call into question the use of dark-blood STIR even with surface coil normalization in acute MI patients.…”

Section: Discussionmentioning

confidence: 85%

“…However, diagnostic uncertainty with dark-blood T2-weighted STIR (related mainly to surface coil sensitivity problems, imaging timing and motion artifact 15 ) has led to alternative approaches. One development with dark-blood STIR has been the use of the body coil instead of a chest wall surface coil, 2,13,14 at the expense of reduced SNR. Use of a surface coil normalization algorithm may also help.…”

Section: Discussionmentioning

confidence: 99%

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Bright-Blood T2-Weighted MRI Has Higher Diagnostic Accuracy Than Dark-Blood Short Tau Inversion Recovery MRI for Detection of Acute Myocardial Infarction and for Assessment of the Ischemic Area at Risk and Myocardial Salvage

Payne

Casey

McClure

et al. 2011

Circ: Cardiovascular Imaging

102

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Background-T2-Weighted MRI reveals myocardial edema and enables estimation of the ischemic area at risk and myocardial salvage in patients with acute myocardial infarction (MI). We compared the diagnostic accuracy of a new bright-blood T2-weighted with a standard black blood T2-weighted MRI in patients with acute MI. Methods and Results-A breath-hold, bright-blood T2-weighted, Acquisition for Cardiac Unified T2 Edema pulse sequence with normalization for coil sensitivity and a breath-hold T2 dark-blood short tau inversion recovery sequence were used to depict the area at risk in 54 consecutive acute MI patients. Infarct size was measured on gadolinium late contrast enhancement images. Compared with dark-blood T2-weighted MRI, consensus agreements between independent observers for identification of myocardial edema were higher with bright-blood T2-weighted MRI when evaluated per patient (PϽ0.001) and per segment of left ventricle (PϽ0.001). Compared with bright-blood T2-weighted MRI, dark-blood T2-weighted MRI underestimated the area at risk compared with infarct size (PϽ0.001). The 95% limits of agreement for interobserver agreements for the ischemic area at risk and myocardial salvage were wider with dark-blood T2-weighted MRI than with bright-blood T2-weighted MRI. Bright blood enabled more accurate identification of the culprit coronary artery with correct identification in 94% of cases compared with 61% for dark blood (PϽ0.001). Conclusions-Bright-blood T2-weighted MRI has higher diagnostic accuracy than dark-blood T2-weighted MRI.Additionally, dark-blood T2-weighted MRI may underestimate area at risk and myocardial salvage. (Circ Cardiovasc Imaging. 2011;4:210-219.)

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Bright-Blood T2-Weighted MRI Has Higher Diagnostic Accuracy Than Dark-Blood Short Tau Inversion Recovery MRI for Detection of Acute Myocardial Infarction and for Assessment of the Ischemic Area at Risk and Myocardial Salvage

Payne

Casey

McClure

et al. 2011

Circ: Cardiovascular Imaging

102

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“…3 However, STEMI survivors are at high risk of recurrent cardiovascular events such as congestive heart failure, arrhythmia, and sudden death. A major determinant of postinfarction mortality and morbidity is the extent of myocardial necrosis after STEMI 4 ; therefore, strategies to limit infarct size (cardioprotection during STEMI) are important. Several mechanical and pharmacological interventions have been proposed as potential cardioprotective therapies, 5 but their use in clinical practice has been limited.…”

mentioning

confidence: 99%

Effect of Early Metoprolol on Infarct Size in ST-Segment–Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention

et al. 2013

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Background-The effect of β-blockers on infarct size when used in conjunction with primary percutaneous coronary intervention is unknown. We hypothesize that metoprolol reduces infarct size when administered early (intravenously before reperfusion). Methods and Results-Patients with Killip class II or less anterior ST-segment-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention within 6 hours of symptoms onset were randomized to receive intravenous metoprolol (n=131) or not (control, n=139) before reperfusion. All patients without contraindications received oral metoprolol within 24 hours. The predefined primary end point was infarct size on magnetic resonance imaging performed 5 to 7 days after STEMI. Magnetic resonance imaging was performed in 220 patients (81%). Mean±SD infarct size by magnetic resonance imaging was smaller after intravenous metoprolol compared with control (25.6±15.3 versus 32.0±22.2 g; adjusted difference, −6.52; 95% confidence interval, −11.39 to −1.78; P=0.012). In patients with pre-percutaneous coronary intervention Thrombolysis in Myocardial Infarction grade 0 to 1 flow, the adjusted treatment difference in infarct size was −8.13 (95% confidence interval, −13.10 to −3.16; P=0.0024). Infarct size estimated by peak and area under the curve creatine kinase release was measured in all study populations and was significantly reduced by intravenous metoprolol. Left ventricular ejection fraction was higher in the intravenous metoprolol group (adjusted difference, 2.67%; 95% confidence interval, 0.09-5.21; P=0.045). The composite of death, malignant ventricular arrhythmia, cardiogenic shock, atrioventricular block, and reinfarction at 24 hours in the intravenous metoprolol and control groups was 7.1% and 12.3%, respectively (P=0.21). Conclusions-In patients with anterior Killip class II or less ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention, early intravenous metoprolol before reperfusion reduced infarct size and increased left ventricular ejection fraction with no excess of adverse events during the first 24 hours after STEMI.

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“…Such factors include persistent or recurrent ischaemia, pressure and volume overload hypertrophy, neurohormonal and biophysical factors, and genetic mechanisms such as adapted gene expression in the setting of heart failure. 10,28,[30][31][32][33][34][35] Thus, based on our findings, we emphasize the importance of taking into account the success of early revascularization when investigating the various mechanisms that are involved in the process of LV remodeling, both in experimental and clinical studies. Limitations: Our study population represents long-term survivors of MI and therefore has the potential risk of selecting patients with a more favorable clinical course.…”

Section: Discussionmentioning

confidence: 55%

Relationship Between Infarct Tissue Characteristics and Left Ventricular Remodeling in Patients With Versus Without Early Revascularization for Acute Myocardial Infarction as Assessed With Contrast-Enhanced Cardiovascular Magnetic Resonance Imaging

et al. 2012

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SummaryLeft ventricular (LV) remodeling following myocardial infarction (MI) is the result of complex interactions between various factors, including presence or absence of early revascularization. The impact of early revascularization on the relationship between infarct tissue characteristics and LV remodeling is incompletely known. Therefore, we investigated in patients with versus without successful early revascularization for acute MI potential relations between infarct tissue characteristics and LV remodeling with contrast-enhanced (CE) cardiovascular magnetic resonance (CMR). Patients with versus without successful early revascularization underwent CE-CMR for tissue characterization and assessment of LV remodeling including end-diastolic and end-systolic volumes, LV ejection fraction, and wall motion score index (WMSI). CE-CMR images were analyzed for infarct tissue characteristics including core-, peri-and total-infarct size, transmural extent, and regional scar scores. In early revascularized patients (n = 46), a larger area of infarct tissue correlated significantly with larger LV dimensions and a more reduced LV function (r = 0.39-0.68; all P ≤ 0.01). Multivariate analyses identified peri-infarct size as the best predictor of LV remodeling parameters (R 2 = 0.44-0.62). In patients without successful early revascularization (n = 47), there was no correlation between infarct area and remodeling parameters; only peri-infarct size versus WMSI (r = 0.33; P = 0.03) and transmural extent versus LVEF (r = -0.27; P = 0.07) tended to be related. A correlation between infarct tissue characteristics and LV remodeling was found only in patients with early successful revascularization. Peri-infarct size was found to be the best determinant of LV remodeling. Our findings stress the importance of taking into account infarct tissue characteristics and success of revascularization when LV remodeling is studied. (Int Heart J 2012; 53: 263-269)

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Predicting late myocardial recovery and outcomes in the early hours of ST-elevation myocardial infarction: traditional measures compared to microvascular perfusion, salvaged myocardium, and necrosis by cardiovascular magnetic resonance

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Cited by 58 publications

References 0 publications

Bright-Blood T2-Weighted MRI Has Higher Diagnostic Accuracy Than Dark-Blood Short Tau Inversion Recovery MRI for Detection of Acute Myocardial Infarction and for Assessment of the Ischemic Area at Risk and Myocardial Salvage

Bright-Blood T2-Weighted MRI Has Higher Diagnostic Accuracy Than Dark-Blood Short Tau Inversion Recovery MRI for Detection of Acute Myocardial Infarction and for Assessment of the Ischemic Area at Risk and Myocardial Salvage

Effect of Early Metoprolol on Infarct Size in ST-Segment–Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention

Relationship Between Infarct Tissue Characteristics and Left Ventricular Remodeling in Patients With Versus Without Early Revascularization for Acute Myocardial Infarction as Assessed With Contrast-Enhanced Cardiovascular Magnetic Resonance Imaging

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