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CLINICAL RESEARCH: CARDIAC IMAGING

Cardiac Magnetic Resonance Imaging Study for Quantification of Infarct Size Comparing Directly Serial Versus Single Time-Point Measurements of Cardiac Troponin T

Evangelos Giannitsis, MD^_*,1,4, Henning Steen, MD^_*,4, Kerstin Kurz, MD^_*, Boris Ivandic, MD^_*, Anke C. Simon, MD^_*, Simon Futterer, MD^_*, Christian Schild, MD^_*, Peter Isfort, MD^_*, Allan S. Jaffe, MD, FACC^,3,_* and Hugo A. Katus, MD, FACC^_*,2

^_* Abteilung Innere Medizin III, Medizinische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Germany
Mayo Clinic and Mayo Medical School, Rochester, Minnesota.

Manuscript received March 23, 2007; revised manuscript received August 10, 2007, accepted September 7, 2007.

^_* Reprint requests and correspondence: Dr. Allan S. Jaffe, Mayo Clinic and Mayo Medical School, CV Division, Gonda 5, 200 First Street SW, Rochester, Minnesota 55905. (Email: Jaffe.Allan{at}mayo.edu).

Objectives: We compared single-point cardiac troponin T (cTnT) measurements with parameters from serial sampling during 96 h after acute myocardial infarction with magnetic resonance imaging measured infarct mass.

Background: Contrast-enhanced magnetic resonance imaging (CE-MRI) allows exact quantification of myocardial infarct size. Clinically, measurement of cardiac biomarkers is a more convenient alternative.

Methods: The CE-MRI infarct mass was determined 4 days after primary percutaneous coronary intervention in 31 ST-segment elevation myocardial infarction (STEMI) and 30 non–ST-segment elevation myocardial infarction (NSTEMI) patients. All single-point, peak, and integrated area under the curve (AUC) cTnT values were plotted against CE-MRI infarct mass.

Results: All single-point and serial cTnT values were significantly higher in STEMI than in NSTEMI (p < 0.01) patients. Except for the admission values, all single-point values on any of the first 4 days, peak cTnT and AUC cTnT were found to correlate comparably well with infarct mass. Among single-point measurements, cTnT on day 4 (cTnTD4) showed highest correlation and performed as well as peak cTnT or AUC cTnT (r = 0.66 vs. r = 0.65 vs. r = 0.69). Receiver-operator characteristic analysis demonstrated that cTnTD4 >0.84 µg/l predicted infarct mass above median as well as peak cTnT >1.57 µg/l or AUC cTnT (receiver-operator characteristic for AUC: 0.839 vs. 0.866 vs. 0.893). However, estimation of infarct mass with cTnTD4, peak cTnT, and AUC cTnT was worse in patients with NSTEMI (r = 0.36, r = 0.5, r = 0.36) than in STEMI (r = 0.75 vs. r = 0.65 vs. r = 0.76).

Conclusions: All single-point cTnTs, except on admission, give a good estimation of infarct size and perform as well as peak cTnT or AUC cTnT. Infarct estimation by single-point measurements, particularly cTnTD4, may gain clinical acceptance because the measurement is easy and inexpensive.

Abbreviations and Acronyms   AMI = acute myocardial infarction   AUC = area under the curve   CE-MRI = contrast-enhanced magnetic resonance imaging   CI = confidence interval   CK-MB = creatine kinase-MB fraction   CMR = cardiovascular magnetic resonance   cTnI/T = cardiac troponin I or T   MR = magnetic resonance   MRI = magnetic resonance imaging   NSTEMI = non–ST-segment elevation myocardial infarction   PCI = percutaneous coronary intervention   ROC = receiver-operator characteristic   SPECT = single-photon emission computed tomography   STEMI = ST-segment elevation myocardial infarction

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