Characterization of the peri-infarct zone by contrast-enhanced cardiac magnetic resonance imaging is a powerful predictor of post-myocardial infarction mortality

Andrew T. Yan, Adolphe J. Shayne, Kenneth A. Brown, Sandeep N. Gupta, Carmen W. Chan, Tuan M. Luu, Marcelo F. Di Carli, H. Glenn Reynolds, William G. Stevenson, Raymond Y. Kwong

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)32-39
Number of pages8
JournalCirculation
Volume114
Issue number1
DOIs
StatePublished - Jul 2006
Externally publishedYes

Keywords

  • Magnetic resonance imaging
  • Myocardial infarction
  • Prognosis

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

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    Yan, A. T., Shayne, A. J., Brown, K. A., Gupta, S. N., Chan, C. W., Luu, T. M., Di Carli, M. F., Reynolds, H. G., Stevenson, W. G., & Kwong, R. Y. (2006). Characterization of the peri-infarct zone by contrast-enhanced cardiac magnetic resonance imaging is a powerful predictor of post-myocardial infarction mortality. Circulation, 114(1), 32-39. https://doi.org/10.1161/CIRCULATIONAHA.106.613414