Late gadolinium enhancement MRI quantification to predict left ventricular remodeling after acute myocardial infarction - 17/09/14
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Abstract |
Objectives |
Infarct size is a major surrogate marker for prognosis in the context of myocardial infarction. There is a growing interest in validating a quantitative assessment approach in order to: (1) standardize these analyses; (2) to precise the individual prognosis of our patients. Several methods are available and were tested across their capacity to predict left ventricular (LV) remodeling at three months.
Patients and methods |
Late gadolinium enhancement-MRI was performed on day 5 and after a period of three months in 92 patients with STEMI. LV volumes and scar parameters were assessed visually (by using a four scale score) and quantitatively on day 5 and at three months. Dichotomous thresholds were defined first visually (VISUAL), then by 2, 5 and 6 standard deviations above remote myocardium, and by the full-width at half-maximum (FWHM) method.
Results |
All infarct sizing methods showed great relation to LV remodeling at three months (ROC analysis). Univariate predictors of an LV end-systolic volume index (LVESVi) superior to 70mL/m2 were: heart failure, creatin kinase peak and infarct size at day 5. FWHM was shown to be the best of all quantitative methods. An infarct size superior to 44 grams predicted a LVESVi>70mL/m2 with a sensitivity of 90% and a specificity of 92.5%. FWHM reproducibility was good (r=0.895, P<0.0001, Bland Altman bias of 0.8g).
Conclusion |
In the context of STEMI, FWHM is a tough and reproducible algorithm to quantitatively assess late gadolinium hyperenhancement, greatly related to functional prognosis at three months follow-up.
Le texte complet de cet article est disponible en PDF.Keywords : CMR, Myocardial infarction, Myocardial scar, Quantitative analysis
Abbreviations : CMR, FWHM, HbA1c, LGE, LV, LVEDVI, LVESVI, LVEF, MVO, PTCA, SD, STEMI
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Vol 35 - N° 4
P. 182-188 - septembre 2014 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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