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Reproducibility of myocardial salvage index in acute myocardial infarction by cardiac magnetic resonance imaging - validation against an angiographic score
Journal of Cardiovascular Magnetic Resonance volume 12, Article number: P226 (2010)
Introduction
Myocardial salvage assessed by cardiac magnetic resonance imaging (MRI) is a new technique which might be used as a surrogate endpoint to reduce the sample size in studies comparing different reperfusion strategies in infarction. So far reproducibility of myocardial salvage has not been evaluated appropriately.
Purpose
The aim of this trial was to assess the reproducibility of myocardial salvage assessment anf to validate it to an angiographic score.
Methods
In 20 patients with reperfused ST-elevation myocardial infarction breath-hold T2-weighted (area at risk [AAR]) and delayed enhancement (infarct size [IS]) images were acquired repeatedly on 2 consecutive days to assess myocardial salvage index (AAR-IS/AAR). Reproducibility, interobserver, and intraobserver variabilities were assessed and compared by Bland-Altman methods. In addition, the AAR at risk in % of left ventricle (%LV) determined by MRI was compared to an angiographic AAR score.
Results
The AAR determined by angiography was 31.0 ± 10.0%LV and by MRI 33.7 ± 9.0%; the MRI IS was 18.2 ± 7.5%LV. The corresponding myocardial salvage index was 43.8 ± 22.5 (range 2.1-77.9). AAR difference (bias) between scan I and scan II was -0.5%LV and limits of agreement were ± 5.9 LV. The results for IS were 0.1 ± 2.2%LV limits of agreement. The resulting bias for myocardial salvage index was -1.7 with limits of agreement of ± 7.2. Intra- and interobserver variability was low with a mean bias of -1.1 (limits of agreement ± 4.7) and 0.3 (limits of agreement ± 4.8), respectively.
Conclusion
Myocardial salvage index assessment by MRI is a reproducible and in comparison to angiographic scores an accurate tool in patients presenting with ST-elevation myocardial infarction. It might therefore serve as a valid surrogate endpoint to uncover advantages of new reperfusion strategies.
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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Thiele, H., Sareban, M., Engelhardt, H. et al. Reproducibility of myocardial salvage index in acute myocardial infarction by cardiac magnetic resonance imaging - validation against an angiographic score. J Cardiovasc Magn Reson 12 (Suppl 1), P226 (2010). https://doi.org/10.1186/1532-429X-12-S1-P226
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DOI: https://doi.org/10.1186/1532-429X-12-S1-P226
Keywords
- Magnetic Resonance Imaging
- Myocardial Infarction
- Acute Myocardial Infarction
- Infarct Size
- Cardiac Magnetic Resonance Imaging