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CLINICAL RESEARCH: CARDIAC IMAGING

Usefulness of a Comprehensive Cardiovascular Magnetic Resonance Imaging Assessment for Predicting Recovery of Left Ventricular Wall Motion in the Setting of Myocardial Stunning

Vicente Bodí, MD, FESC^_*,_*, Juan Sanchis, MD, FESC^_*, María P. López-Lereu, MD, Antonio Losada, MD^_*, Julio Núñez, MD^_*, Mauricio Pellicer, MD^_*, Vicente Bertomeu, MD^_*, Francisco J. Chorro, MD, FESC^_* and Àngel Llácer, MD, FESC^_*

^_* Cardiology Department, Hospital Clínico y Universitario de Valencia, Universidad de Valencia, Valencia, Spain
Cardiovascular Magnetic Resonance Imaging Unit, ERESA, Valencia, Spain.

Manuscript received April 27, 2005; revised manuscript received June 11, 2005, accepted July 6, 2005.

^_* Reprint requests and correspondence: Dr. Vicente Bodí, Cardiology Department, Hospital Clínico y Universitario de Valencia, Blasco Ibáñez 17, 46010, Valencia, Spain. (Email: vicentbodi{at}hotmail.com).

OBJECTIVES: We sought to evaluate the usefulness of a comprehensive assessment of four cardiovascular magnetic resonance imaging (CMR)-derived myocardial viability indexes in the setting of myocardial stunning.

BACKGROUND: Cardiovascular magnetic resonance imaging allows the simultaneous assessment of several viability indexes.

METHODS: We studied 40 patients with a first ST-segment elevation myocardial infarction (MI) and an open infarct-related artery. At the first week, using CMR, wall motion (WM), and four viability indexes were determined: wall thickness, WM improvement with low-dose dobutamine, perfusion, and transmural extent of necrosis. We created a comprehensive score based on the presence and the relative power of these viability indexes for predicting normal WM at the sixth month.

RESULTS: Of 153 dysfunctional segments at the first week, 59 (39%) exhibited normal WM at the sixth month. According to the odds ratio of viability indexes for predicting normal WM, we developed a five-level predictive score. The proportions of segments showing normal WM at sixth month were as follows; Level 1 (0 indexes): 0 of 13 (0%); Level 2 (normal thickness and/or perfusion): 14 of 82 (17%); Level 3 (dobutamine response): 5 of 11 (45%); Level 4 (non-transmural necrosis): 20 of 26 (77%); Level 5 (non-transmural necrosis and dobutamine response): 20 of 21 (95%), p < 0.0001 for the trend. These proportions were similar in a matched prospective validation group comprising 16 patients (0%, 18%, 62%, 77%, and 90% for levels 1 to 5, respectively, p < 0.0001 for the trend).

CONCLUSIONS: A comprehensive analysis of the four more widely used CMR-derived viability indexes is useful for predicting late systolic function after myocardial infarction.

Abbreviations and Acronyms   CMR = cardiovascular magnetic resonance imaging   IRA = infarct-related artery   MI = myocardial infarction   TIMI = Thrombolysis In Myocardial Infarction   TrueFISP = true fast imaging with steady state precession   WM = wall motion

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