Defining left ventricular remodeling following acute ST-segment elevation myocardial infarction using cardiovascular magnetic resonance.

Autor: Bulluck H; The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, London, UK. h.bulluck@gmail.com.; The National Institute of Health Research, University College London Hospitals, Biomedical Research Centre, London, UK. h.bulluck@gmail.com.; National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore. h.bulluck@gmail.com., Go YY; National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore., Crimi G; Struttura Complessa Cardiologia, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Policlinico San Matteo, Pavia, Italy., Ludman AJ; Royal Devon and Exeter Hospital, NHS Foundation Trust, Exeter, UK., Rosmini S; Barts Heart Centre, St Bartholomew's Hospital, London, UK., Abdel-Gadir A; Barts Heart Centre, St Bartholomew's Hospital, London, UK., Bhuva AN; Barts Heart Centre, St Bartholomew's Hospital, London, UK., Treibel TA; Barts Heart Centre, St Bartholomew's Hospital, London, UK., Fontana M; Royal Free Hospital, London, UK., Pica S; Struttura Complessa Cardiologia, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Policlinico San Matteo, Pavia, Italy.; Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, Milan, Italy., Raineri C; Struttura Complessa Cardiologia, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Policlinico San Matteo, Pavia, Italy., Sirker A; The National Institute of Health Research, University College London Hospitals, Biomedical Research Centre, London, UK.; Barts Heart Centre, St Bartholomew's Hospital, London, UK., Herrey AS; Barts Heart Centre, St Bartholomew's Hospital, London, UK.; Royal Free Hospital, London, UK., Manisty C; The National Institute of Health Research, University College London Hospitals, Biomedical Research Centre, London, UK.; Barts Heart Centre, St Bartholomew's Hospital, London, UK., Groves A; UCL Institute of Nuclear Medicine, University College London Hospital, London, UK., Moon JC; The National Institute of Health Research, University College London Hospitals, Biomedical Research Centre, London, UK.; Barts Heart Centre, St Bartholomew's Hospital, London, UK., Hausenloy DJ; The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, London, UK.; The National Institute of Health Research, University College London Hospitals, Biomedical Research Centre, London, UK.; National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore.; Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore, Singapore.; Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore.
Jazyk: angličtina
Zdroj: Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance [J Cardiovasc Magn Reson] 2017 Mar 13; Vol. 19 (1), pp. 26. Date of Electronic Publication: 2017 Mar 13.
DOI: 10.1186/s12968-017-0343-9
Abstrakt: Background: The assessment of post-myocardial infarction (MI) left ventricular (LV) remodeling by cardiovascular magnetic resonance (CMR) currently uses criteria defined by echocardiography. Our aim was to provide CMR criteria for assessing LV remodeling following acute MI.
Methods: Firstly, 40 reperfused ST-segment elevation myocardial infarction (STEMI) patients with paired acute (4 ± 2 days) and follow-up (5 ± 2 months) CMR scans were analyzed by 2 independent reviewers and the minimal detectable changes (MDCs) for percentage change in LV end-diastolic volume (%ΔLVEDV), LV end-systolic volume (%ΔLVESV), and LV ejection fraction (%ΔLVEF) between the acute and follow-up scans were determined. Secondly, in 146 reperfused STEMI patients, receiver operator characteristic curve analyses for predicting LVEF <50% at follow-up (as a surrogate for clinical poor clinical outcome) were undertaken to obtain cut-off values for %ΔLVEDV and %ΔLVESV.
Results: The MDCs for %ΔLVEDV, %ΔLVESV, and %ΔLVEF were similar at 12%, 12%, 13%, respectively. The cut-off values for predicting LVEF < 50% at follow-up were 11% for %ΔLVEDV on receiver operating characteristic curve analysis (area under the curve (AUC) 0.75, 95% CI 0.6 to 0.83, sensitivity 72% specificity 70%), and 5% for %ΔLVESV (AUC 0.83, 95% CI 0.77 to 0.90, sensitivity and specificity 78%). Using cut-off MDC values (higher than the clinically important cut-off values) of 12% for both %ΔLVEDV and %ΔLVESV, 4 main patterns of LV remodeling were identified in our cohort: reverse LV remodeling (LVEF predominantly improved); no LV remodeling (LVEF predominantly unchanged); adverse LV remodeling with compensation (LVEF predominantly improved); and adverse LV remodeling (LVEF unchanged or worsened).
Conclusions: The MDCs for %ΔLVEDV and %ΔLVESV between the acute and follow-up CMR scans of 12% each may be used to define adverse or reverse LV remodeling post-STEMI. The MDC for %ΔLVEF of 13%, relative to baseline, provides the minimal effect size required for investigating treatments aimed at improving LVEF following acute STEMI.
Databáze: MEDLINE
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