Prognostic Impact of Contrast-Enhanced CMR Early after Acute ST Segment Elevation Myocardial Infarction (STEMI) in a Regional STEMI Network

Bruder, Oliver; Breuckmann, Frank; Jensen, Christoph J; Jochims, Markus; Naber, Christoph; Barkhausen, Jörg; Erbel, Raimund; Sabin, Georg

doi:10.1007/s00059-008-3102-8

Cited by 42 publications

(19 citation statements)

References 33 publications

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“…Persistent microvascular obstruction was not documented in our patient groups with acute myocarditis or Tako-tsubo cardiomyopathy. Microvascular obstruction in STEMI patients has been detected in 57.5% up to 90% [20][21][22][23][24], which is higher compared to our reported frequency. We like to stress that the evidence of persistent microvascular obstruction, which is defined as persistent late-hypoenhancement within a hyperenhanced area [6], represents the most severe form of microvascular obstruction without myocardial perfusion.…”

Section: Discussioncontrasting

confidence: 76%

Characterization of patients with acute chest pain using cardiac magnetic resonance imaging

Hombach

Merkle

Kestler

et al. 2010

Clin Res Cardiol Suppl

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Aims The purpose of this study was to evaluate whether CMRI provides characteristic findings in patients with acute chest pain suffering from ST-elevation-myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), acute myocarditis or Tako-tsubo cardiomyopathy. Patients and Methods 230 consecutive patients with acute chest pain underwent cardiac catheterization followed by CMRI within median 5 d. Patients were classified to suffer from STEMI (n = 102), NSTEMI (n = 89), acute myocarditis (n = 27), or Tako-tsubo cardiomyopathy (n = 12) on the synopsis of all clinical data. Wall motion abnormalities, late enhancement (LE), persistent microvascular obstruction as well ventricular volumes and functions were assessed by CMRI. ResultsRight and left ventricular volumes were significantly different between the groups and values were highest in patients with acute myocarditis. Wall motion abnormalities were observed in 100% of STEMI, 75% of NSTEMI, 67% of acute myocarditis and 100% of Tako-tsubo patients. There was a characteristic pattern of abnormal wall motion focused on midventricular-apical segments in patients with Tako-tsubo cardiomyopathy, depending on the culprit vessel in patients with STEMI/NSTEMI and with a random distribution in patients with acute myocarditis. LE was mainly subendocardial or transmural in patients with STEMI (93.2%) or NSTEMI (62.9%). LE was diffuse, intramural or subepicardial in patients with acute myocarditis. No LE was observed in patients with Tako-tsubo cardiomyopathy. Persistent microvascular obstruction was only visualized in patients STEMI (33%) or NSTEMI (6%). Conclusions Cardiac magnetic resonance imaging provides characteristic patterns of LE, persistent microvascular obstruction and wall motion abnormalities that allow a differentiation between patients with acute chest pain from coronary and non-coronary origin.

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Section: Discussioncontrasting

confidence: 76%

Characterization of patients with acute chest pain using cardiac magnetic resonance imaging

Hombach

Merkle

Kestler

et al. 2010

Clin Res Cardiol Suppl

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“…6). The presence of microvascular obstruction has a profound impact on prognosis, independent of the degree of LV dysfunction or infarct size [51,52], even in the patients who have undergone successful primary PCI [53]. In one such study, of 184 patients who had undergone CMR after successful primary PCI, microvascular obstruction was associated with an OR of 8.7 of further major adverse cardiac events during 1-year follow-up, even after adjustment for other prognostic indices [54].…”

Section: Acute Coronary Syndromesmentioning

confidence: 98%

Recent Developments in Outcomes Research in Cardiovascular MRI

Daly

Coelho‐Filho

Kwong

2010

curr cardiovasc imaging rep

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Since the start of this millennium, cardiovascular MRI (CMR) has made large strides toward technical optimization, and the impressive range and capability afforded by CMR has gained its widespread acceptance as the gold standard cardiac imaging technique for a range of diagnostic indications. Such has been the pace of developments in the field, both software and hardware related, that for the initial years of this decade the focus of most research was on novel techniques and applications. However, as these techniques have become refined and established, and the technique has become more widely available in clinical settings, there is a growing body of work addressing the prognostic implications of CMR findings. This article explores recent developments in the evaluation of clinical outcomes according to CMR and how this builds on our current knowledge in the field.

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“…The STEMI network prefers transfer to PCI over fibrinolysis and includes the evaluation of myocardial damage by CMR [26,27]. Apart from that, all patients gave written informed consent prior to CMR imaging.…”

Section: Patientsmentioning

confidence: 99%

Relation of B-type natriuretic peptide (BNP) and infarct size as assessed by contrast-enhanced MRI

Bruder

Jensen

Jochims

et al. 2010

International Journal of Cardiology

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Prognostic Impact of Contrast-Enhanced CMR Early after Acute ST Segment Elevation Myocardial Infarction (STEMI) in a Regional STEMI Network

Abstract: NR as a correlate of microvascular obstruction remains independently related to prognosis in patients with acute myocardial infarction treated by PCI.

Cited by 42 publications

References 33 publications

Characterization of patients with acute chest pain using cardiac magnetic resonance imaging

Characterization of patients with acute chest pain using cardiac magnetic resonance imaging

Recent Developments in Outcomes Research in Cardiovascular MRI

Relation of B-type natriuretic peptide (BNP) and infarct size as assessed by contrast-enhanced MRI

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