Quantitative Tissue Characterization of Infarct Core and Border Zone in Patients With Ischemic Cardiomyopathy by Magnetic Resonance Is Associated With Future Cardiovascular Events

Shahriar Heidary, Harendra Patel, Jaehoon Chung, Hajime Yokota, Sandeep N. Gupta, Mihoko V. Bennett, Chandra Katikireddy, Patricia Nguyen, John M. Pauly, Masahiro Terashima, Michael V. McConnell, Phillip C. Yang

Research output: Contribution to journalArticle

Abstract

Objectives: This study evaluates how characterization of tissue heterogeneity of myocardial infarction by cardiovascular magnetic resonance (CMR) is associated with cardiovascular events (CVE) in patients with ischemic cardiomyopathy (ICM). Background: Prior studies demonstrated that the quantification of myocardial scar volume by CMR is superior to left ventricular end-diastolic volume, left ventricular end-systolic volume, and left ventricular ejection fraction (LVEF) in predicting future CVE in ICM patients. Evaluation of infarct heterogeneity by measuring infarct core and border zones through CMR might have a higher association with CVE. Methods: Seventy patients (mean LVEF: 25 ± 11%) considered for revascularization or medical management ± implantable cardiac defibrillator were enrolled. A 1.5-T GE MRI (Signa, GE Healthcare, Milwaukee, Wisconsin) was used to acquire cine and delayed enhancement images. The patients' core and border zones of infarcted myocardium were analyzed and followed for CVE. Results: Larger infarct border zone and its percentage of myocardium were found in the 29 patients (41%) who had CVE (median 13.3 g [interquartile range (IQR) 8.4 to 25.1 g] vs. 8.0 g [IQR 3.0 to 14.5 g], p = 0.02 and 7.8% [IQR 4.9% to 17.0%] vs. 4.1% [IQR 1.9% to 9.3%], p = 0.02, respectively). The core infarct zone and its percentage of myocardium, left ventricular end-diastolic volume, left ventricular end-systolic volume, and LVEF were not statistically significant. Sub-analysis of the medical management and revascularization patients with CVE demonstrated that the medically managed patients had a larger border zone, whereas there was no difference between border and core zones in the revascularization group (p <0.05). Conclusions: Quantification of core and border zones and their percentages of myocardium through CMR is associated with future CVE and might assist in the management of patients with ICM.

Original languageEnglish (US)
Pages (from-to)2762-2768
Number of pages7
JournalJournal of the American College of Cardiology
Volume55
Issue number24
DOIs
StatePublished - Jun 15 2010
Externally publishedYes

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Cardiomyopathies
Stroke Volume
Magnetic Resonance Spectroscopy
Myocardium
Image Enhancement
Implantable Defibrillators
Cicatrix
Myocardial Infarction
Delivery of Health Care

Keywords

  • arrhythmia
  • ischemic cardiomyopathy
  • magnetic resonance imaging
  • myocardial infarction
  • prognosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Quantitative Tissue Characterization of Infarct Core and Border Zone in Patients With Ischemic Cardiomyopathy by Magnetic Resonance Is Associated With Future Cardiovascular Events. / Heidary, Shahriar; Patel, Harendra; Chung, Jaehoon; Yokota, Hajime; Gupta, Sandeep N.; Bennett, Mihoko V.; Katikireddy, Chandra; Nguyen, Patricia; Pauly, John M.; Terashima, Masahiro; McConnell, Michael V.; Yang, Phillip C.

In: Journal of the American College of Cardiology, Vol. 55, No. 24, 15.06.2010, p. 2762-2768.

Research output: Contribution to journalArticle

Heidary, S, Patel, H, Chung, J, Yokota, H, Gupta, SN, Bennett, MV, Katikireddy, C, Nguyen, P, Pauly, JM, Terashima, M, McConnell, MV & Yang, PC 2010, 'Quantitative Tissue Characterization of Infarct Core and Border Zone in Patients With Ischemic Cardiomyopathy by Magnetic Resonance Is Associated With Future Cardiovascular Events', Journal of the American College of Cardiology, vol. 55, no. 24, pp. 2762-2768. https://doi.org/10.1016/j.jacc.2010.01.052
Heidary, Shahriar ; Patel, Harendra ; Chung, Jaehoon ; Yokota, Hajime ; Gupta, Sandeep N. ; Bennett, Mihoko V. ; Katikireddy, Chandra ; Nguyen, Patricia ; Pauly, John M. ; Terashima, Masahiro ; McConnell, Michael V. ; Yang, Phillip C. / Quantitative Tissue Characterization of Infarct Core and Border Zone in Patients With Ischemic Cardiomyopathy by Magnetic Resonance Is Associated With Future Cardiovascular Events. In: Journal of the American College of Cardiology. 2010 ; Vol. 55, No. 24. pp. 2762-2768.
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abstract = "Objectives: This study evaluates how characterization of tissue heterogeneity of myocardial infarction by cardiovascular magnetic resonance (CMR) is associated with cardiovascular events (CVE) in patients with ischemic cardiomyopathy (ICM). Background: Prior studies demonstrated that the quantification of myocardial scar volume by CMR is superior to left ventricular end-diastolic volume, left ventricular end-systolic volume, and left ventricular ejection fraction (LVEF) in predicting future CVE in ICM patients. Evaluation of infarct heterogeneity by measuring infarct core and border zones through CMR might have a higher association with CVE. Methods: Seventy patients (mean LVEF: 25 ± 11{\%}) considered for revascularization or medical management ± implantable cardiac defibrillator were enrolled. A 1.5-T GE MRI (Signa, GE Healthcare, Milwaukee, Wisconsin) was used to acquire cine and delayed enhancement images. The patients' core and border zones of infarcted myocardium were analyzed and followed for CVE. Results: Larger infarct border zone and its percentage of myocardium were found in the 29 patients (41{\%}) who had CVE (median 13.3 g [interquartile range (IQR) 8.4 to 25.1 g] vs. 8.0 g [IQR 3.0 to 14.5 g], p = 0.02 and 7.8{\%} [IQR 4.9{\%} to 17.0{\%}] vs. 4.1{\%} [IQR 1.9{\%} to 9.3{\%}], p = 0.02, respectively). The core infarct zone and its percentage of myocardium, left ventricular end-diastolic volume, left ventricular end-systolic volume, and LVEF were not statistically significant. Sub-analysis of the medical management and revascularization patients with CVE demonstrated that the medically managed patients had a larger border zone, whereas there was no difference between border and core zones in the revascularization group (p <0.05). Conclusions: Quantification of core and border zones and their percentages of myocardium through CMR is associated with future CVE and might assist in the management of patients with ICM.",
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AU - Heidary, Shahriar

AU - Patel, Harendra

AU - Chung, Jaehoon

AU - Yokota, Hajime

AU - Gupta, Sandeep N.

AU - Bennett, Mihoko V.

AU - Katikireddy, Chandra

AU - Nguyen, Patricia

AU - Pauly, John M.

AU - Terashima, Masahiro

AU - McConnell, Michael V.

AU - Yang, Phillip C.

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N2 - Objectives: This study evaluates how characterization of tissue heterogeneity of myocardial infarction by cardiovascular magnetic resonance (CMR) is associated with cardiovascular events (CVE) in patients with ischemic cardiomyopathy (ICM). Background: Prior studies demonstrated that the quantification of myocardial scar volume by CMR is superior to left ventricular end-diastolic volume, left ventricular end-systolic volume, and left ventricular ejection fraction (LVEF) in predicting future CVE in ICM patients. Evaluation of infarct heterogeneity by measuring infarct core and border zones through CMR might have a higher association with CVE. Methods: Seventy patients (mean LVEF: 25 ± 11%) considered for revascularization or medical management ± implantable cardiac defibrillator were enrolled. A 1.5-T GE MRI (Signa, GE Healthcare, Milwaukee, Wisconsin) was used to acquire cine and delayed enhancement images. The patients' core and border zones of infarcted myocardium were analyzed and followed for CVE. Results: Larger infarct border zone and its percentage of myocardium were found in the 29 patients (41%) who had CVE (median 13.3 g [interquartile range (IQR) 8.4 to 25.1 g] vs. 8.0 g [IQR 3.0 to 14.5 g], p = 0.02 and 7.8% [IQR 4.9% to 17.0%] vs. 4.1% [IQR 1.9% to 9.3%], p = 0.02, respectively). The core infarct zone and its percentage of myocardium, left ventricular end-diastolic volume, left ventricular end-systolic volume, and LVEF were not statistically significant. Sub-analysis of the medical management and revascularization patients with CVE demonstrated that the medically managed patients had a larger border zone, whereas there was no difference between border and core zones in the revascularization group (p <0.05). Conclusions: Quantification of core and border zones and their percentages of myocardium through CMR is associated with future CVE and might assist in the management of patients with ICM.

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KW - arrhythmia

KW - ischemic cardiomyopathy

KW - magnetic resonance imaging

KW - myocardial infarction

KW - prognosis

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