Risk stratification after myocardial infarction: A reappraisal in the era of thrombolysis

Touboul, P; André‐Fouët, Xavier; Leizorovicz, Alain; Itti, R.; Lopez, Michel; Sayegh, Yehia; Milon, H; Kirkorian, Gilbert

doi:10.1093/oxfordjournals.eurheartj.a015125

Cited by 51 publications

(11 citation statements)

References 30 publications

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“…The use of gated SPECT to assess left ventricular function from perfusion data is the innovative methodological contribution of this study. Although area at risk and final infarct size are considered reliable surrogate end-points for studies comparing different treatment strategies in acute myocardial infarction [22], the prognostic implications of left ventricular ejection fraction and left ventricular volumes are well known [23][24][25]. Gated SPECT could be particularly advantageous for this kind of study, given that it allows reproducible assessment of both perfusion and functional changes [2-5, 16, 17, 26].…”

Section: Discussionmentioning

confidence: 99%

Use of 99mTc-sestamibi gated SPECT to assess the influence of anterograde flow before primary coronary angioplasty on tissue salvage and functional recovery in acute myocardial infarction

Leoncini

Bellandi

Sciagrà

et al. 2004

Eur J Nucl Med Mol Imaging

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Abstract.Purpose: Preserved thrombolysis in myocardial infarction (TIMI) flow before percutaneous coronary intervention (PCI) in acute myocardial infarction is related to improved outcome. Gated single-photon emission computed tomography (SPECT) allows the simultaneous assessment of left ventricular perfusion and function. We evaluated the initial risk area and subsequent evolution of perfusion and function according to TIMI flow before successful primary PCI. Methods: In 36 patients, treated with abciximab, primary PCI and stenting, 99m Tc-sestamibi was injected before PCI and gated SPECT acquired thereafter. Gated SPECT was repeated 7 and 30 days later. Perfusion defect, wall motion score index, left ventricular ejection fraction and volumes were examined. Results: Before PCI, 14 patients (group A) showed TIMI flow 2-3 and 22 (group B) TIMI flow 0-1, but no differences in clinical variables, initial risk area, wall motion score, ejection fraction or volumes. Perfusion defect was smaller in group A at 7 (9%±11% vs 19%±14%, p<0.02) and 30 days (7%±7% vs 16%±12%, p<0.02) and the salvage index was higher at 30 days (77%±22% vs 55%±28%, p<0.02). Wall motion score was lower in group A at 30 days (p<0.05). Ejection fraction significantly improved in both groups at 7 and 30 days. Enddiastolic volume showed a trend towards a reduction in group A, whilst it was significantly increased in group B. Conversely, end-systolic volume was significantly decreased in group A but remained unchanged in group B. Conclusion: In the setting of optimal myocardial reperfusion for myocardial infarction, preserved TIMI flow before PCI does not limit the initial risk area but it does improve myocardial salvage and functional recovery.

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Section: Discussionmentioning

confidence: 99%

Use of 99mTc-sestamibi gated SPECT to assess the influence of anterograde flow before primary coronary angioplasty on tissue salvage and functional recovery in acute myocardial infarction

Leoncini

Bellandi

Sciagrà

et al. 2004

Eur J Nucl Med Mol Imaging

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“…remodeling prediction; magnetic resonance imaging; infarct size; ejection fraction MYOCARDIAL INFARCTION (MI) is commonly followed by adverse left ventricular (LV) remodeling involving significant changes in LV geometry and function (4). Such adverse remodeling contributes to impaired cardiac function and is a major cause of heart failure and increased mortality (25). Experimental models of MI, for example, as induced by permanent coronary ligation in gene-modified mice, are extensively utilized to elucidate pathophysiological and molecular mechanisms underlying cardiac remodeling that could be therapeutically targeted (5,17,18,22,23,27).…”

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confidence: 99%

MRI-based prediction of adverse cardiac remodeling after murine myocardial infarction

Protti

Dong²,

Sirker³

et al. 2012

American Journal of Physiology-Heart and Circulatory Physiology

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Protti A, Dong X, Sirker A, Botnar R, Shah AM. MRI-based prediction of adverse cardiac remodeling after murine myocardial infarction. Am J Physiol Heart Circ Physiol 303: H309 -H314, 2012. First published May 25, 2012; doi:10.1152/ajpheart.00208.2012 results in adverse cardiac remodeling leading to heart failure and increased mortality. Experimental mouse models of MI are extensively used to identify mechanisms underlying adverse remodeling, but the extent of remodeling that occurs may be highly variable and can limit the utility to discover new disease pathways. The ability to predict the development of significant late post-MI remodeling would be invaluable in conducting such studies by increasing throughput and efficiency. This study aimed to identify potential thresholds of cardiac magnetic resonance imaging (MRI) parameters measured early after murine MI that would predict the development of significant adverse remodeling at 4 wk. MI was achieved by permanent coronary ligation and animals (n ϭ 84) were followed up for 4 wk subsequently. MRI was used to assess left ventricular (LV) volumes, mass and ejection fraction, as well as infarct size (IS). Late gadolinium enhancement cine-MRI was performed at 2 days with standard cine-MRI at 30 days post-MI. Utilizing multiple logistic regression, we found that IS Ͼ36%, at 2 days post-MI, was the overall best single predictor of adverse remodeling at 30 days (sensitivity 80.7%, specificity 88.9%; C-statistic of 0.939 from receiver-operating curve analysis). LV end-systolic volume (LVESV) Ͼ32 l was also an excellent predictor comparable to IS. The combination of IS Ͼ36% and/or LVESV Ͼ32 l provided the highest predictive values for late adverse remodeling among multiple predictors. This study demonstrates that MRIbased estimation of IS and ESV during the acute phase of murine MI are good predictors of subsequent adverse remodeling that may aid experimental design. remodeling prediction; magnetic resonance imaging; infarct size; ejection fraction MYOCARDIAL INFARCTION (MI) is commonly followed by adverse left ventricular (LV) remodeling involving significant changes in LV geometry and function (4). Such adverse remodeling contributes to impaired cardiac function and is a major cause of heart failure and increased mortality (25). Experimental models of MI, for example, as induced by permanent coronary ligation in gene-modified mice, are extensively utilized to elucidate pathophysiological and molecular mechanisms underlying cardiac remodeling that could be therapeutically targeted (5,17,18,22,23,27). The extent of adverse remodeling that occurs after experimental MI in murine models, as manifest by an increase in LV end-diastolic and end-systolic volumes (LVEDV and LVESV, respectively) and a reduction in ejection fraction (EF), can be highly variable and can limit their utility to discover new disease pathways (23,29). This is most likely related to variations in the severity and extent of myocardial injury that is induced by coronary ligation in mouse models (15,23,28,2...

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“…It represents an important cause of heart failure and is a predictor of mortality [2,3]. Several factors have been demonstrated to influence the evolution of LV volumes after AMI, among which there are size, location and transmurality of the infarction, residual viability in the infarct territory and patency of the infarct-related artery [4].…”

Section: Introductionmentioning

confidence: 99%

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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Risk stratification after myocardial infarction: A reappraisal in the era of thrombolysis

Cited by 51 publications

References 30 publications

Use of 99mTc-sestamibi gated SPECT to assess the influence of anterograde flow before primary coronary angioplasty on tissue salvage and functional recovery in acute myocardial infarction

Use of 99mTc-sestamibi gated SPECT to assess the influence of anterograde flow before primary coronary angioplasty on tissue salvage and functional recovery in acute myocardial infarction

MRI-based prediction of adverse cardiac remodeling after murine myocardial infarction

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

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