Premium
A comparison of infarct mass by cardiac magnetic resonance and real time myocardial perfusion echocardiography as predictors of major adverse cardiac events following reperfusion for ST elevation myocardial infarction
Author(s) -
Lenz Charles J,
Abdelmoneim Sahar S,
Anavekar Nandan S,
Foley Thomas A,
Nhola Lara F,
Huang Runqing,
Oh Jae K,
Mulvagh Sharon L
Publication year - 2016
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.13308
Subject(s) - medicine , cardiology , myocardial infarction , timi , thrombolysis , cardiac magnetic resonance imaging , reperfusion therapy , perfusion , percutaneous coronary intervention , magnetic resonance imaging , radiology
Purpose Infarct mass as assessed by myocardial‐delayed enhancement imaging on cardiac magnetic resonance ( CMR ) and myocardial blood flow as assessed by real time myocardial perfusion echocardiography ( RT ‐ MPE ) have been shown to predict adverse events following ST elevation myocardial infarction ( STEMI ). There has been no published comparison of quantitative assessment using these modalities as predictors of clinical outcomes to date. We compared RT ‐ MPE with CMR for prediction of cardiac events in reperfused STEMI patients. Materials and Methods Consecutive STEMI patients with early reperfusion were studied. RT ‐ MPE and CMR were performed. Perfusion score indices ( PSI RT ‐ MPE and PSI CMR ) were calculated [sum of segmental perfusion scores/number of segments]. CMR infarct mass (g) and RT ‐ MPE myocardial blood flow ( MBF dB /s) were quantified. Patients were followed for cardiac events (death, nonfatal MI , revascularization, angina, and heart failure). Results All 27 patients (age 62±14; follow‐up 3.5±2.6 years) had thrombolysis in myocardial infarction ( TIMI ) grade 3 flow of infarct vessel. Cardiac events occurred in 17 (63%). Cardiac event patients had higher PSI RT ‐ MPE , PSI CMR , infarct mass, and lower MBF . PSI RT ‐ MPE cutoff of 0.3 had an AUC of 0.856 (82% sensitivity, 70% specificity), while a PSI CMR cutoff of 0.2 had an AUC of 0.765 (76% sensitivity, 60% specificity). Infarct mass and MBF were independent predictors of cardiac events after adjusting for risk factors (hazard ratios: 20.9 [95% CI 1.8–256] P =.02 and 8.1 [95% CI 1.5–78] P =.01, respectively). Conclusions Quantitative RT ‐ MPE performed comparably to CMR for prediction of MACE in STEMI patients supporting a prognostic role for this noninvasive, bedside imaging method.