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CLINICAL RESEARCH: PROGNOSTICATORS IN ACUTE INFARCTION

Prognostic Value of Myocardial Infarct Size and Contractile Reserve Using Magnetic Resonance Imaging

Sebastian Kelle, MD^_*,_*, Stijntje D. Roes, MD, Christoph Klein, MD^_*, Thomas Kokocinski, MD^_*, Albert de Roos, MD, Eckart Fleck, MD^_*, Jeroen J. Bax, MD and Eike Nagel, MD

^_* Department of Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
Departments of Radiology and Cardiology, Leiden University Medical Center, Leiden, the Netherlands
Kings College London, Division of Imaging Sciences, London, United Kingdom

Manuscript received April 22, 2009; revised manuscript received July 13, 2009, accepted July 23, 2009.

^_* Reprint requests and correspondence: Dr. Sebastian Kelle, German Heart Institute Berlin, Department of Medicine/Cardiology, Augustenburger Platz 1, 13353 Berlin, Germany (Email: kelle{at}dhzb.de).

Objectives: Our aim was to assess the predictive value of myocardial infarct size assessed with late gadolinium-enhanced (LGE) magnetic resonance imaging (MRI) in medically treated patients with chronic myocardial infarction relative to contractile reserve on low-dose dobutamine magnetic resonance (DSMR) for long-term event-free survival.

Background: Information on the relative merits of scar tissue and contractile reserve to predict long-term prognosis in patients with chronic myocardial infarction is lacking.

Methods: A total of 177 patients with known coronary artery disease and scar tissue on LGE MRI were enrolled. Left ventricular (LV) functional parameters at rest and during low-dose DSMR were assessed, and the wall motion score index was calculated.

Results: Eleven patients (6.2%) suffered an event during follow-up (average 20.3 months). Infarct size was a stronger predictor of events than LV ejection fraction and LV volumes at rest and during low-dose DSMR. Myocardial infarct size was used to separate patients at high risk (spatial extent 6 segments, n = 98) from those at low risk (spatial extent <6 segments, n = 79) for mortality. In the subgroup of patients at high risk, transmurality of infarct was not a predictor of events. However, the presence of contractile reserve (n = 63) was associated with a significantly higher number of events (12.7%) compared with no change in wall motion score index (6.7%; n = 15; p = 0.008).

Conclusions: Myocardial infarct size on LGE MRI is a stronger predictor of clinical outcome than contractile reserve in medically treated patients with myocardial infarction. In patients with large myocardial scar, the presence of contractile reserve is more important for the prediction of events than scar tissue.

Key Words: cardiac magnetic resonance • prognosis • delayed enhancement • contractile reserve

Abbreviations and Acronyms   CI = confidence interval   DSMR = dobutamine magnetic resonance   LGE = late gadolinium enhancement   LV = left ventricle/ventricular   LVEDV = left ventricular end-diastolic volume   LVEF = left ventricular ejection fraction   LVESV = left ventricular end-systolic volume   MRI = magnetic resonance imaging   WMSI = wall motion score index

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J. Am. Coll. Cardiol. 2009 54: A40. [Full Text] [PDF]