Risk stratification by cardiac magnetic resonance imaging after ST-elevation myocardial infarction

Abstract

The comprehensive evaluation of STEMI patients by CMR imaging has the potential to provide incremental prognostic information for risk stratification beyond established clinical risk markers. In light of the lack of trials, however, designed to prospectively test the value of a CMR-guided therapeutic strategy in patients with STEMI, the use of CMR for risk stratification of the postinfarction patient awaits further validation and research.

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

“…CMR and single photon emission tomography are techniques allowing visualization of AAR and IS [72]; however, based on the higher spatial resolution and the possibility to determine both AAR and IS in a single examination, CMR has emerged as preferred imaging modality for this purpose [73]. T2-weighted edema imaging, particularly short-tau inversion recovery (STIR) sequence, is widely used to determine AAR by CMR [54,74]. As described in detail above, IS quantification is performed by using LGE CMR [73].…”

“…Although quantification of AAR and subsequently myocardial salvage using CMR has limitations (e.g., low signal-to-noise ratio, motion artifacts, incomplete blood suppression) and is still discussed controversially [75], AAR and particularly myocardial salvage index have clearly shown to predict function recovery as well as adverse remodeling and clinical events following STEMI [76,77]. Although IS represents a robust surrogate endpoint for prognosis, myocardial salvage index may be particularly preferred to evaluate therapeutic efficacy in clinical trials [74]. This is based on the fact that myocardial edema can relevantly differ also in patients with similar resulting IS [78,79].…”

Relationship between diabetes and ischaemic injury among patients with revascularized ST‐elevation myocardial infarction

“…In patients with ST‐elevation myocardial infarction (STEMI), the risk of future adverse clinical events is closely associated with the amount of salvaged myocardium, irreversible myocardial damage and left ventricular (LV) dysfunction . Cardiac magnetic resonance (CMR) has emerged as the reference technique to comprehensively quantify reversible and irreversible ischaemic injury of the myocardium and its microvasculature as well as to determine systolic dysfunction in vivo …”

Shock Index as a Predictor of Myocardial Damage and Clinical Outcome in ST-Elevation Myocardial Infarction

“…[13][14][15][16][17][18][19] In the present study, we therefore sought to explore the relationship of the admission shock index with myocardial damage as visualized by CMR, and to determine the prognostic value of the shock index in a large multicenter cohort of STEMI patients.…”