TY - JOUR
T1 - Characterization of the peri-infarct zone by contrast-enhanced cardiac magnetic resonance imaging is a powerful predictor of post-myocardial infarction mortality
AU - Yan, Andrew T.
AU - Shayne, Adolphe J.
AU - Brown, Kenneth A.
AU - Gupta, Sandeep N.
AU - Chan, Carmen W.
AU - Luu, Tuan M.
AU - Di Carli, Marcelo F.
AU - Reynolds, H. Glenn
AU - Stevenson, William G.
AU - Kwong, Raymond Y.
PY - 2006/7
Y1 - 2006/7
N2 - BACKGROUND - Accurate risk stratification is crucial for effective treatment planning after myocardial infarction (MI). Previous studies suggest that the peri-infarct border zone may be an important arrhythmogenic substrate. In this pilot study, we tested the hypothesis that the extent of the peri-infarct zone quantified by contrast-enhanced cardiac magnetic resonance (CMR) is an independent predictor of post-MI mortality. METHODS AND RESULTS - We studied 144 patients with documented coronary artery disease and abnormal myocardial delayed enhancement (MDE) consistent with MI. A computer-assisted, semiautomatic algorithm quantified the total infarct size and divided it into the core and peri-infarct regions based on signal-intensity thresholds (>3 SDs and 2 to 3 SDs above remote normal myocardium, respectively). The peri-infarct zone was normalized as a percentage of the total infarct size (%MDEperiphery). After a median follow-up of 2.4 years, 29 (20%) patients died. Patients with an above-median %MDEperiphery were at higher risk for death compared with those with a below-median %MDE periphery (28% versus 13%, log-rank Pperiphery were the strongest predictors of all-cause mortality (adjusted hazard ratio [HR] for %MDEperiphery, 1.45 per 10% increase; P=0.002) and cardiovascular mortality (adjusted HR, 1.51 per 10% increase; P=0.009). Similarly, after adjusting for age and left ventricular ejection fraction, %MDEperiphery maintained strong and independent associations with all-cause mortality (adjusted HR, 1.42; P=0.005) and cardiovascular mortality (adjusted HR, 1.49; P=0.01). CONCLUSIONS - In patients with a prior MI, the extent of the peri-infarct zone characterized by CMR provides incremental prognostic value beyond left ventricular systolic volume index or ejection fraction. Infarct characteristics by CMR may prove to be a unique and valuable noninvasive predictor of post-MI mortality.
AB - BACKGROUND - Accurate risk stratification is crucial for effective treatment planning after myocardial infarction (MI). Previous studies suggest that the peri-infarct border zone may be an important arrhythmogenic substrate. In this pilot study, we tested the hypothesis that the extent of the peri-infarct zone quantified by contrast-enhanced cardiac magnetic resonance (CMR) is an independent predictor of post-MI mortality. METHODS AND RESULTS - We studied 144 patients with documented coronary artery disease and abnormal myocardial delayed enhancement (MDE) consistent with MI. A computer-assisted, semiautomatic algorithm quantified the total infarct size and divided it into the core and peri-infarct regions based on signal-intensity thresholds (>3 SDs and 2 to 3 SDs above remote normal myocardium, respectively). The peri-infarct zone was normalized as a percentage of the total infarct size (%MDEperiphery). After a median follow-up of 2.4 years, 29 (20%) patients died. Patients with an above-median %MDEperiphery were at higher risk for death compared with those with a below-median %MDE periphery (28% versus 13%, log-rank Pperiphery were the strongest predictors of all-cause mortality (adjusted hazard ratio [HR] for %MDEperiphery, 1.45 per 10% increase; P=0.002) and cardiovascular mortality (adjusted HR, 1.51 per 10% increase; P=0.009). Similarly, after adjusting for age and left ventricular ejection fraction, %MDEperiphery maintained strong and independent associations with all-cause mortality (adjusted HR, 1.42; P=0.005) and cardiovascular mortality (adjusted HR, 1.49; P=0.01). CONCLUSIONS - In patients with a prior MI, the extent of the peri-infarct zone characterized by CMR provides incremental prognostic value beyond left ventricular systolic volume index or ejection fraction. Infarct characteristics by CMR may prove to be a unique and valuable noninvasive predictor of post-MI mortality.
KW - Magnetic resonance imaging
KW - Myocardial infarction
KW - Prognosis
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U2 - 10.1161/CIRCULATIONAHA.106.613414
DO - 10.1161/CIRCULATIONAHA.106.613414
M3 - Article
C2 - 16801462
AN - SCOPUS:33746206339
SN - 0009-7322
VL - 114
SP - 32
EP - 39
JO - Circulation
JF - Circulation
IS - 1
ER -