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  • Poster presentation
  • Open Access

Prognostic role of CMR in acute myocardial infarction

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  • 1,
  • 1,
  • 1,
  • 1 and
  • 1
Journal of Cardiovascular Magnetic Resonance201012 (Suppl 1) :P293

https://doi.org/10.1186/1532-429X-12-S1-P293

  • Published:

Keywords

  • Acute Myocardial Infarction
  • Cardiac Magnetic Resonance
  • Prognostic Role
  • Left Ventricular Remodel
  • Prognostic Accuracy

Introduction

Cardiac Magnetic Resonance (CMR) provides a comprehensive non-invasive characterization of acute myocardial infarction (MI).

Purpose

to test whether a single CMR study may improve the prognostic stratification of MI patients.

Methods

29 patients were studied on day 3 ± 1 after a first MI, between June 2006 and April 2007. CMR included SSFP and T2 STIR sequences, first pass perfusion, Early (EGE: 1 to 2 minutes) and Late (LGE: 10 to 15 minutes) Gadolinium Enhancement. Subsequent clinical management was not affected from CMR results, and patients underwent the usual clinical and echocardiographic follow-up. In 2009 we tested the occurrence of the end-point of cardiac death or left ventricular (LV) remodelling (EDVi > 90 ml/m2 or LVEF < 50% at echocardiographic follow-up) in the studied population.

Results

At 23 ± 5 months follow-up, the endpoint was observed in 7 pts (25%): 1 cardiac death, 6 adverse LV remodeling. See Table 1 for the prognostic role of different CMR parameters: among the tested parameters, myocardial haemorrhage, observed in 8 pts (27%), has a unique 96,5% accuracy in predicting the endpoint, with a 100% NPV. Unexpectedly, LGE-based parameters such as total infarct mass and the presence MVO show prognostic accuracy similar to the echocardiographic LVEF <50%. The 7 pts reaching the endpoint show both MVO (globally present in 15 pts -51%-) and Myocardial Haemorrhage. It seems that the assessment of MVO should keep in account the total amount and not only the mere presence of MVO: this hampers the usefulness of MVO, since the total amount changes over time.

Table 1

 

Patients n

(%)

Positive Predictive Value %

Negative Predictive Value %

Accuracy %

LGE

(>20% LV mass)

13 (44%)

53,8

93,8

72.4

MVO (present)

15 (51%)

46.7

100

72.4

LVEF

(< 50%)

14 (48%)

50.0

100

75.9

Area at risk (>40% LV mass)

9

(31%)

55.5

90

79.3

Myocardial Haemorrhage

8

(27%)

87.5

100

96.5

Conclusion

T2-STIR images allow a long-term prognostic stratification of unrivalled accuracy during the acute phase of MI. The use of gadolinium do not significantly improve the prognostic accuracy of CMR.

Authors’ Affiliations

(1)
Istituto Clinico Humanitas, Rozzano, Italy

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