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Recovery of left ventricular dysfunction after ST-elevation myocardial infarction: comparison between 2D Doppler echocardiography and contrast enhanced cardiac MRI

Background

The role of contrast enhanced cardiac MRI (ceMRI) in predicting recovery of left ventricular dysfunction is evolving; yet transthoracic echocardiography (TTE) has not been evaluated in this manner.

Methods

Patients with acute ST-elevation MI (STEMI) admitted to Mayo Clinic from August, 2007 to September, 2008 who received reperfusion therapy were screened with TTE and ceMRI. Patients with ceMRI evidence of a previous MI were excluded. Left ventricular dysfunction was defined as an ejection fraction (LVEF) < 50%.

Results

Of 116 patients screened, 91 met inclusion criteria and 56 patients completed follow-up imaging (3-79 weeks). 89% of both the imaging studies were completed within 3 days of the index MI and 32 (57%) patients had a baseline LVEF <50%. The ability of ceMRI and TTE variables to predict normalization of LVEF was assessed using ROC analysis. Delayed enhancement left ventricular mass index (DEi) (DEi <20% 35/56 (63%) was the strongest (AUC 0.86, p=0.0004) predictor of LVEF recovery with a sensitivity, specificity, positive predictive value, and negative predictive value of 0.79, 0.92, 0.94, and 0.75 respectively. When combined with DEi, wall motion score index (WMSI) significantly correlated with follow-up EF (r=0.81, p<0.0001) and overall change in EF (r=0.73, p<0.001). Acute measures of diastolic function did not meaningfully predict LVEF recovery.

Conclusions

A DEi of <20%, as assessed by ceMRI, is the strongest predictor of LVEF normalization in patients with acute post-STEMI left ventricular dysfunction. As compared with TTE, ceMRI provides uniquely valuable information for the long-term management of post-STEMI patients.

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Correspondence to Daniel M Couri.

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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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Couri, D.M., Martinez, M.W., Syed, I.S. et al. Recovery of left ventricular dysfunction after ST-elevation myocardial infarction: comparison between 2D Doppler echocardiography and contrast enhanced cardiac MRI. J Cardiovasc Magn Reson 13, P120 (2011). https://doi.org/10.1186/1532-429X-13-S1-P120

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Keywords

  • Myocardial Infarction
  • Ventricular Dysfunction
  • Mayo Clinic
  • Diastolic Function
  • Left Ventricular Dysfunction