Predicting late myocardial recovery and outcomes in the early hours of ST-elevation myocardial infarction: traditional m
- PDF / 362,306 Bytes
- 2 Pages / 610 x 792 pts Page_size
- 53 Downloads / 202 Views
BioMed Central
Open Access
Oral presentation
Predicting late myocardial recovery and outcomes in the early hours of ST-elevation myocardial infarction: traditional measures compared to microvascular perfusion, salvaged myocardium, and necrosis by cardiovascular magnetic resonance Eric Larose*, Josep Rodés-Cabau, Philippe Pibarot, Stéphane Rinfret, Guy Proulx, Can M Nguyen, Jean-Pierre Déry, Onil Gleeton, Louis Roy, Bernard Noel, Gérald Barbeau, Jacques Rouleau, Jean-Rock Boudreault, Marc Amyot, Robert De Larochellière and Olivier F Bertrand Address: Quebec Heart Institute at Laval Hospital, Quebec, QC, Canada * Corresponding author
from 13th Annual SCMR Scientific Sessions Phoenix, AZ, USA. 21-24 January 2010 Published: 21 January 2010 Journal of Cardiovascular Magnetic Resonance 2010, 12(Suppl 1):O77
doi:10.1186/1532-429X-12-S1-O77
Abstracts of the 13th Annual SCMR Scientific Sessions - 2010
Meeting abstracts - A single PDF containing all abstracts in this Supplement is available here. http://www.biomedcentral.com/content/files/pdf/1532-429X-11-S1-infoThis abstract is available from: http://jcmr-online.com/content/12/S1/O77 © 2010 Larose et al; licensee BioMed Central Ltd.
Introduction Earlier prediction of poor outcomes following ST-elevation myocardial infarction (STEMI) is desirable as it may allow tailored therapy at the earliest possible time when benefits may be greatest and optimized patient orientation in a managed care setting.
Purpose Determine whether a very early imaging strategy may improve the prediction of late systolic dysfunction and poor outcomes in STEMI.
Methods 103 patients with acute STEMI were studied by contrastenhanced cardiovascular magnetic resonance (CE-CMR) within 12 h of primary angioplasty and after infarct healing at 6 months, and followed clinically beyond 2 years. The primary endpoints were LVEF change and LV dysfunction, while poor outcomes were a key secondary endpoint.
Results
compensated systolic function during STEMI developed late LV dysfunction. Late gadolinium enhancement (LGE) volume maintained a stronger association to LVEF change than infarct transmurality, microvascular obstruction, or myocardial salvage during STEMI (p = 0.02). Multivariable logistic regression identified LGE volume during STEMI as the best predictor of late LV dysfunction (OR 1.36, p = 0.03 adjusted for traditional predictors). An LGE ≥ 30% of LV or 18 mL/m2 during STEMI correctly classified 89% of patients for late LV dysfunction. LGE volume during STEMI provided important incremental benefit for predicting late dysfunction (AUC = 0.92) beyond infarct territory, pain-to-balloon time, maximum CKMB rise, presence of Q waves, and LVEF during STEMI (p ≤ 0.03 for each). Twenty-three patients developed poor outcomes (1 death, 2 myocardial infarctions, 5 malignant arrhythmias requiring AICD, 4 severe LV dysfunction < 35%, 11 hospitalizations for heart failure) during 2.6 ± 0.9 year followup; LGE volume remained a strong independent predictor of poor outcomes, whereas LGE ≥ 30% or 18 m
Data Loading...
