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.
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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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