Prediction of Left Ventricular Remodeling and Analysis of Infarct Resorption in Patients with Reperfused Myocardial Infarcts by Using Contrast-enhanced MR Imaging

Lund, Gunnar; Stork, Alexander; Muellerleile, Kai; Barmeyer, Achim; Bansmann, Martin; Knefel, Meike; Schlichting, U.; Mûller, Martín; Verde, Pablo Emilio; Adam, Gerhard; Meinertz, Thomas; Saeed, Maythem

doi:10.1148/radiol.2451061219

Cited by 111 publications

(106 citation statements)

References 25 publications

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“…We observed that infarct size and severity could be significant predictors of LV remodelling. Several clinical studies demonstrated that various parameters are predictive of remodelling, including anterior infarct location, patency of the infarctrelated artery, perfusion and functional parameters [4][5][6][7][8][9][10][11][12][13]. In agreement with these previous findings, the present study showed a number of baseline parameters predictive of remodelling, infarct severity demonstrating the best predictive value.…”

Section: Discussionsupporting

confidence: 90%

“…Identification of lowrisk patients allows focusing the attention on higher-risk patients who would need a more aggressive therapy and clinical follow-up. Interestingly, the infarct size threshold that we found most effective was practically the same that has been reported using cardiac magnetic resonance imaging [8].…”

Section: Discussionsupporting

confidence: 83%

“…However, we did not register a significant difference in infarct size reduction between patients with and without LV remodelling. Therefore, we were unable to confirm the cardiac magnetic resonance data showing that patients with LV remodelling had substantially larger infarct resorption compared with patients without remodelling [8]. Conversely, our study demonstrates that the reduction of infarct size beyond the subacute phase may occur in all patients, in agreement with prior scintigraphic reports [6,24,25].…”

Section: Discussioncontrasting

confidence: 76%

“…The main novel findings of this study are the following: (1) among perfusion parameters, infarct severity was the only significant predictor of LV remodelling according to multivariate analysis and (2) infarct resorption was comparable in patients with and without LV remodelling, despite previous results with cardiac magnetic resonance imaging reporting greater infarct resorption in patients with remodelling [8].…”

Section: Discussioncontrasting

confidence: 48%

“…Orn et al [7] showed that only scar size, but neither location nor transmurality, was the primary determinant of long-term LV remodelling. Lund et al [8] identified an infarct size threshold of 24% as predictive of LV remodelling; moreover, they found that patients with LV remodelling had a greater infarct size reduction, i.e. larger infarct resorption, than patients with preserved LV volumes.…”

Section: Introductionmentioning

confidence: 99%

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Relationship between infarct size and severity measured by gated SPECT and long-term left ventricular remodelling after acute myocardial infarction

Berti

Sciagrà

Acampa

et al. 2011

Eur J Nucl Med Mol Imaging

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Purpose After acute myocardial infarction (AMI), left ventricular (LV) remodelling may occur despite successful reperfusion. This study aimed to investigate by gated single photon emission computed tomography (SPECT) the longterm evolution of myocardial perfusion and LV function after AMI and to identify the predictors of LV remodelling. Methods Sixty-eight AMI patients successfully treated by primary percutaneous coronary intervention underwent 99m Tc-sestamibi gated SPECT at 1 month (baseline) and over 6-month follow-up after the acute event. LV remodelling was defined as 20% increase in LV end-diastolic volume at follow-up. Results At baseline, patients with remodelling (n=14) showed larger (infarct size 29.3±7.8%) and more transmural (infarct severity 0.28±0.10) infarctions, and reduced LV ejection fraction (35.4±5.6%), but similar LV volume indexes, compared to patients without remodelling (n=54) (infarct size 20.8±14.4%, p<0.05, infarct severity 0.40± 0.11, p<0.001, ejection fraction 44.5±9.2, p<0.001). At stepwise multivariate regression analysis, infarct severity showed the best predictive value for predicting LV remodelling (F = 5.54, p < 0.05). Using the thresholds identified by receiver-operating characteristic curve analysis, infarct size and severity detected patients with remodelling with 75% accuracy and 95% negative predictive value. Infarct resorption (defined as the defect size difference between follow-up and baseline) was comparable between patients with (−4.4±8.4%) and without remodelling (−6.8±9.4%) (p=NS). Conclusion Perfusion parameters assessed by gated SPECT in the subacute phase after successfully treated AMI correlate with changes in functional parameters at long-term followup. Infarct severity is more effective than infarct size, but both are helpful for predicting LV remodelling.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 83%

Section: Discussioncontrasting

confidence: 76%

Section: Discussioncontrasting

confidence: 48%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Relationship between infarct size and severity measured by gated SPECT and long-term left ventricular remodelling after acute myocardial infarction

Berti

Sciagrà

Acampa

et al. 2011

Eur J Nucl Med Mol Imaging

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Magnetic Resonance for Functional Testing and Interventional Guidance

Koestner

2010

Current Best Practice in Interventional Cardiology

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Identification of residual ischemia, infarction, and microvascular impairment in revascularized myocardial infarction using 64‐slice MDCT

Furtado

Carlsson

Wintermark

et al. 2008

Contrast Media & Molecular

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This study aimed to assess the potential of 64-slice MDCT in characterizing revascularized infarcted myocardium at the cellular and microvascular levels. Pigs (n = 7) underwent 2 h left anterior descending coronary artery occlusion/reperfusion. In acute (2-4 h) and subacute (1 week) infarction, first-pass perfusion (FPP) (1 ml/kg of 300 mg/ml Omnipaque) was performed using a cine (rotation time 60 s/bpm) non-ECG gated sequence (mAS/kV = 100/120). Delayed contrast enhanced images (DE) (mAS/kV = 650/120) were acquired every 2 min for 10 min to determine the kinetics of Omnipaque and to define infarcted myocardium and microvascular impairment (representing microvascular obstruction and/or no- or low-reflow phenomenon). Maximum upslope, maximum attenuation and time to the peak were measured from FPP plots. 2,3,5-Triphenyltetrazolium-chloride (TTC) was used to define true infarction in the excised hearts. Hyperenhanced myocardium on DE was measured and compared with TTC. The contrast media caused minor beam hardening and X-ray scatter on FPP. The above-mentioned perfusion parameters significantly differed between remote and acute infarction. Infarcted myocardium showed two patterns of enhancement on DE, hyperenhanced rim representing the perfused infarction and hypoenhanced core representing a microvascular impaired region, with significantly different attenuation. The extent of infarction on DE-MDCT decreased over the course of 1 week and did not differ from TTC. Post-processed FPP semi-quantitative images showed a decline in myocardial blood volume and flow in acute revascularized infarction. In conclusion, modern MDCT has the potential to identify residual ischemia on FPP and microvascular impairment and infarction on DE images.

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Prediction of Left Ventricular Remodeling and Analysis of Infarct Resorption in Patients with Reperfused Myocardial Infarcts by Using Contrast-enhanced MR Imaging

Abstract: Infarct size 24% or more of the LV area constitutes an important threshold to predict remodeling. Patients with remodeling develop disproportionate infarct resorption.

Cited by 111 publications

References 25 publications

Relationship between infarct size and severity measured by gated SPECT and long-term left ventricular remodelling after acute myocardial infarction

Relationship between infarct size and severity measured by gated SPECT and long-term left ventricular remodelling after acute myocardial infarction

Magnetic Resonance for Functional Testing and Interventional Guidance

Identification of residual ischemia, infarction, and microvascular impairment in revascularized myocardial infarction using 64‐slice MDCT

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