Coronary artery disease
Comparison of Myocardial Infarct Size Assessed With Contrast-Enhanced Magnetic Resonance Imaging and Left Ventricular Function and Volumes to Predict Mortality in Patients With Healed Myocardial Infarction

https://doi.org/10.1016/j.amjcard.2007.04.029Get rights and content

Currently, left ventricular (LV) ejection fraction (EF) and/or LV volumes are the established predictors of mortality in patients with coronary artery disease (CAD) and severe LV dysfunction. With contrast-enhanced magnetic resonance imaging (MRI), precise delineation of infarct size is now possible. The relative merits of LVEF/LV volumes and infarct size to predict long-term outcome are unknown. The purpose of this study was to determine the predictive value of infarct size assessed with contrast-enhanced MRI relative to LVEF and LV volumes for long-term survival in patients with healed myocardial infarction. Cine MRI and contrast-enhanced MRI were performed in 231 patients with healed myocardial infarction. LVEF and LV volumes were measured and infarct size was derived from contrast-enhanced MRI. Nineteen patients (8.2%) died during a median follow-up of 1.7 years (interquartile range 1.1 to 2.9). Cox proportional hazards analysis revealed that infarct size defined as spatial extent (hazard ratio [HR] 1.3, 95% confidence interval [CI] 1.1 to 1.6, chi-square 6.7, p = 0.010), transmurality (HR 1.5, 95% CI 1.1 to 1.9, chi-square 8.9, p = 0.003), or total scar score (HR 6.2, 95% CI 1.7 to 23, chi-square 7.4, p = 0.006) were stronger predictors of all-cause mortality than LVEF and LV volumes. In conclusion, infarct size on contrast-enhanced MRI may be superior to LVEF and LV volumes for predicting long-term mortality in patients with healed myocardial infarction.

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Study population

This was a prospective, follow-up study that involved 2 hospitals. Consecutive patients (n = 231), referred for MRI to evaluate cardiac function and extent of scar tissue for clinical reasons, with a history of CAD and evidence of scar tissue on contrast-enhanced MRI, were enrolled. Patients with myocardial infarction <3 months before cardiac MRI were excluded. Other exclusion criteria were (supra-) ventricular arrhythmias, pacemakers, intracranial clips, and claustrophobia. Patient

Study population

Clinical data are presented in Table 1; 231 patients with scar tissue on contrast-enhanced MRI were included (106 at the Leiden University Medical Center, The Netherlands, and 125 at the German Heart Institute, Germany). All patients had evidence of CAD on angiography and 84% had a previous myocardial infarction; 16% had a clinically unrecognized myocardial infarction. MRI was performed >2 years after infarction in 52% of the patients.

MRI variables

MRI findings are listed in Table 2. Median LVEF in the total

Discussion

The main finding in this study is that myocardial infarct size on contrast-enhanced MRI, expressed as either spatial extent, transmurality of scar tissue, or total scar score is a stronger predictor of long-term mortality than LV function and/or LV volumes in patients with healed myocardial infarction.

MRI has emerged as a reliable noninvasive technique for assessment of scar tissue in patients with CAD.12, 15 Kim et al16 validated the value of contrast-enhanced MRI to detect scar tissue in an

References (29)

  • H.D. White et al.

    Left ventricular end-systolic volume as the major determinant of survival after recovery from myocardial infarction

    Circulation

    (1987)
  • P. Kansal et al.

    Infarct size by contrast-enhanced magnetic resonance imaging predicts cardiovascular outcome after acute myocardial infarction

    J Cardiovasc Magnetic Res

    (2006)
  • H.J. Lamb et al.

    Echo planar MRI of the heart on a standard system: validation of measurements of left ventricular function and mass

    J Comput Assist Tomogr

    (1996)
  • R.J. van der Geest et al.

    Comparison between manual and semiautomated analysis of left ventricular volume parameters from short-axis MR images

    J Comput Assist Tomogr

    (1997)
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