Quantification of myocardium at risk in ST- elevation myocardial infarction: a comparison of contrast-enhanced steady-state free precession cine cardiovascular magnetic resonance with coronary angiographic jeopardy scores

Abstract

BackgroundClinical outcome following acute myocardial infarction is predicted by final infarct size evaluated in relation to left ventricular myocardium at risk (MaR). Contrast-enhanced steady-state free precession (CE-SSFP) cardiovascular magnetic resonance imaging (CMR) is not widely used for assessing MaR. Evidence of its utility compared to traditional assessment methods and as a surrogate for clinical outcome is needed.MethodsRetrospective analysis within a study evaluating post-conditioning during ST elevation myocardial infarction (STEMI) treated with coronary intervention (n = 78). CE-SSFP post-infarction was compared with angiographic jeopardy methods. Differences and variability between CMR and angiographic methods using Bland-Altman analyses were evaluated. Clinical outcomes were compared to MaR and extent of infarction.ResultsMaR showed correlation between CE-SSFP, and both BARI and APPROACH scores of 0.83 (p < 0.0001) and 0.84 (p < 0.0001) respectively. Bias between CE-SSFP and BARI was 1.1% (agreement limits -11.4 to +9.1). Bias between CE-SSFP and APPROACH was 1.2% (agreement limits -13 to +10.5). Inter-observer variability for the BARI score was 0.56 ± 2.9; 0.42 ± 2.1 for the APPROACH score; -1.4 ± 3.1% for CE-SSFP. Intra-observer variability was 0.15 ± 1.85 for the BARI score; for the APPROACH score 0.19 ± 1.6; and for CE-SSFP -0.58 ± 2.9%.ConclusionQuantification of MaR with CE-SSFP imaging following STEMI shows high correlation and low bias compared with angiographic scoring and supports its use as a reliable and practical method to determine myocardial salvage in this patient population.Trial registrationClinical trial registration information for the parent clinical trial:Karolinska Clinical Trial Registration (2008)Unique identifier: CT20080014. Registered 04th January 2008Electronic supplementary materialThe online version of this article (doi:10.1186/s12968-017-0359-1) contains supplementary material, which is available to authorized users.

Role of Cardiac Magnetic Resonance to Improve Risk Prediction following Acute ST-elevation Myocardial Infarction

“…Indeed, experimental studies found a high accuracy and precision for contrast-enhanced SSFP based AAR estimation in vivo and ex vivo [82]. In addition, AAR quantification with contrast-enhanced SSFP imaging following STEMI has a strong correlation and low bias compared with angiographic scoring [83]. A comparison between T2-STIR and contrast-enhanced cine CMR from a DANAMI 3 sub-study revealed a higher validity for contrast-enhanced cine CMR [84].…”

Remote ischemic conditioning protects against endothelial ischemia-reperfusion injury via a glucagon-like peptide-1 receptor-mediated mechanism in humans

“…T1-and T2-weighted imaging reliably depict MaR up to one week after the myocardial infarction 101,102 . Contrast-enhanced steady state free precession imaging provides superior image quality to T2-weighted imaging and has been validated against SPECT 103 and angiographic scores 104 . Still, there has been some debate regarding the validity of CMR based evaluation of MaR 105,106 and the most appropriate timing for it, considering the bimodal pattern of edema after myocardial infarction [107][108][109][110] .…”

Assessment of myocardial salvage in patients with STEMI undergoing thrombolysis: ticagrelor versus clopidogrel

“…Second, while it is known that CMR represents a widely used method of measuring the myocardial AAR during the acute phase of myocardial infarction, in our study this parameter was estimated using angiographic scoring systems. However, it should be emphasized that AAR calculated by either the BARI or the APPROACH score demonstrates a very good correlation with the respective CMR-derived values, particularly in patients presenting with STEMI [ 38 , 39 ]. In fact, estimation of MSI by combining angiographic assessment of AAR and FIS estimation by CMR has been outlined as a valid alternative [ 19 ].…”