Comparison of visual scoring and quantitative planimetry methods for estimation of global infarct size on delayed enhanced cardiac MRI and validation with myocardial enzymes
Introduction
The precise quantification of infarcted myocardium in the setting of ischaemic cardiomyopathy and the distinction between viable and nonviable myocardium are important for the therapeutic management of acute myocardial infarction (AMI) patients [1]. In patients with AMI, infarct size (IS) has been shown to be a very strong factor of prediction of adverse outcome [2].
Delayed enhanced-cardiac magnetic resonance (DE-CMR) imaging has emerged and been confirmed as a reference tool for the assessment of infarcted myocardium with high spatial resolution and high levels of reproducibility [3], [4], [5]. An increasing number of patients are referred to CMR centers after acute myocardial infarction (AMI) for cardiac evaluation of their infarcted myocardium and of its consequences on left ventricular (LV) function [6].
Yet, various arbitrary methods have been employed to quantify IS from DE-CMR from simple quantitative planimetry with different signal intensity thresholdings to more complex computer-assisted methods [7], [8], [9], [10], [11]. All of these methods have various levels of accuracy and are time- and software-consuming.
Until now, no one has validated an ideal and practical method to define infarct size by DE-CMR available for daily clinical practice. A global visual segmental scoring has been described by Comte et al. [9] with good levels of accuracy compared to quantitative planimetry but its accuracy on a wide range of infarct sizes and its correlation with myocardial biomarkers and LV functional parameters remains unknown.
Our principal objective was to assess the visual segmental scoring for infarct size quantification in a group of patients with a wide range of reperfused acute coronary syndromes against quantitative planimetry and our secondary objective was to assess this method's relation with myocardial biomarkers and LV functional parameters.
Section snippets
Study population
A total of 103 patients prospectively admitted to our intensive care unit for acute myocardial infarction with or without ST-elevation were included between May 2005 and December 2008. All patients gave written informed consent according to the ethics committee of our institution standards.
Acute ST-elevated myocardial infarction (STEMI) was defined as follows: typical symptoms of acute coronary syndrome evolving for less than 6 h; persistent ST-segment elevation on admission 12-lead ECG over two
Patients
The study population comprised 103 patients (77 men, 26 women) with a mean age of 61 ± 13 years; 24 patients were admitted for NSTEMI and 79 were admitted for STEMI. MRI studies were performed 4 ± 2 days after admission.
The mean LVEF was 52.3 ± 11.6%, mean LVEDV was 132 ± 35 mL and mean LVESV was 65 ± 29 mL. The principal infarct location was anterior in 31% (n = 32) of the patients, inferior in 56% (n = 58) and lateral in 13% (n = 13).
Intra- and inter-observer variability
There was an excellent intra-observer variability (r = 0.95; y = 0.96x + 3.81; SEE =
Discussion
In this study we confirm that the global visual segmental scoring is an accurate, easy-access and quick method to assess IS on DE-CMR. In addition, we show that this method correlates significantly with other direct or indirect markers of IS (myocardial biomarkers and LV functional parameters).
Disclosures
Nathan Mewton was funded by a research grant from the French Federation of Cardiology (Fédération Française de Cardiologie).
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