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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

^_* Cardiology
Physiology
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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