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CLINICAL RESEARCH: CARDIAC IMAGING

Acute Myocardial Infarction Early Viability Assessment by 64-Slice Computed Tomography Immediately After Coronary Angiography

Comparison With Low-Dose Dobutamine Echocardiography

Michel Habis, MD^_*,_*, André Capderou, MD, PhD, Saïd Ghostine, MD^_*, Béatrice Daoud, MD, Christophe Caussin, MD^_*, Jean-Yves Riou, MD, Philippe Brenot, MD, Claude Yves Angel, MD, Bernard Lancelin, MD^_* and Jean-François Paul, MD

^_* Department of Cardiology, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France
Department of Physiology, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France
Department of Radiology, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France.

Manuscript received September 19, 2006; revised manuscript received November 28, 2006, accepted December 21, 2006.

^_* Reprint requests and correspondence: Dr. Michel Habis, Centre Chirurgical Marie Lannelongue, 133 avenue de la Resistance, 92350 Le Plessis Robinson, France. (Email: mhabis{at}ccml.fr).

Objectives: Early evaluation of myocardial viability in acute myocardial infarction is useful to guide therapy. Therefore, we assessed 64-slice computed tomography (CT) immediately after coronary angiography in this setting.

Background: Recent preliminary studies have shown the promising usefulness of late hyperenhancement multislice computed tomography (MSCT) for non-viability assessment.

Methods: Thirty-six patients admitted for a first acute myocardial infarction had a coronary angiogram early after admission followed by 64-slice CT without iodine reinjection. The 16 segments of the left ventricle depicted by the American Society of Echocardiography were graded: no, subendocardial, or transmural hyperenhancement. No or subendocardial hyperenhancement were expected to reflect viability. Two to 4 weeks later, the same segments’ contractility was evaluated at rest. Low-dose dobutamine echocardiography was performed in case of akinetic segment at rest.

Results: Mean delay between coronary angiography and MSCT was 24 ± 11 min (range 7 to 51 min). We compared 576 segments evaluated by each method. Agreement was noted for 560 segments (97%) and disagreement for 16 segments (3%). Thus, 64-slice CT after coronary angiography for an acute myocardial infarction had 98% sensitivity, 94% specificity, 97% accuracy, and 99% positive and 79% negative predictive values for detecting viable myocardial segments at a very early stage of an acute myocardial infarction. On a per-patient analysis, sensitivity, specificity, accuracy, and positive and negative predictive values were 92%, 100%, 94%, and 100% and 85%, respectively.

Conclusions: A 64-slice CT after coronary angiography for an acute myocardial infarction is a promising method for early evaluation of viable myocardium.

Abbreviations and Acronyms   AMI = acute myocardial infarction   CT = computed tomography   MRI = magnetic resonance imaging   MSCT = multislice computed tomography   WMSI = wall motion score index

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