SCMR-LAC

Prognostic Value of a Comprehensive Cardiac Magnetic Resonance Assessment Soon After a First ST-Segment Elevation Myocardial Infarction

Realmente un gran logro de la RMC para el seguimiento de los pacientes pos-IAM con elevación del segmento ST tratados bien sea con trombolítico o angioplastia primaria. La importancia de poder estratificar nuestros pacientes posterior a un evento cardíaco es uno de los mayores aportes que este método ha brindado a todos los cardiólogos clínicos, no solo para predecir eventos , si no también para optimizar cada día mejor el tratamiento medicamentoso con el fin de mejorar la calidad de vida de estos pacientes.

Vicente Bodi, MD*,*, Juan Sanchis, MD*, Julio Nunez, MD*, Luis Mainar, MD*, Maria P. Lopez-Lereu, MD , Jose V. Monmeneu, MD , Eva Rumiz, MD*, Fabian Chaustre*, Isabel Trapero*, Oliver Husser, MD*, Maria J. Forteza*, Francisco J. Chorro, MD*, Angel Llacer, MD*

Cardiology Department, Hospital Clinico Universitario, Universidad de Valencia, Valencia, Spain

Objectives: To evaluate the prognostic value of a comprehensive cardiac magnetic resonance (CMR) assessment soon after a first ST-segment elevation myocardial infarction (STEMI).

Background: CMR allows for a simultaneous assessment of wall motion abnormalities (WMA), WMA with low-dose dobutamine (WMA-dobutamine), microvascular obstruction, and transmural necrosis. This approach has been proven to be useful to predict late systolic recovery soon after STEMI. Its prognostic value and the relative prognostic weight of these indexes are not well-defined.

Methods: We studied 214 consecutive patients with a first STEMI treated with thrombolytic therapy or primary angioplasty discharged from hospital. In the first week (7 ± 1 day after infarction), with CMR we determined the extent (number of segments) of WMA, WMA-dobutamine, microvascular obstruction, and transmural necrosis.

Results: During a median follow-up of 553 days, 21 major adverse cardiac events (MACE) including 4 cardiac deaths, 6 nonfatal myocardial infarctions, and 11 readmissions for heart failure were documented. The MACE was associated with a larger extent of WMA (8 ± 4 segments vs. 5 ± 3 segments, p < 0.001), WMA-dobutamine (6 ± 4 segments vs. 4 ± 3 segments, p = 0.004), microvascular obstruction (3 ± 3 segments vs. 1 ± 2 segments p <0.001), and transmural necrosis (7 ± 3 segments vs. 3 ± 3 segments, p < 0.001). In a complete multivariate analysis that included baseline characteristics, electrocardiogram, biomarkers, angiography, ejection fraction, left ventricular volumes, and all CMR indexes, WMA/segment (hazard ratio: 1.29 [95% confidence interval: 1.11 to 1.49], p = 0.001) and the extent of transmural necrosis/segment (hazard ratio: 1.30 [95% confidence interval: 1.12 to 1.51], p < 0.001) were the only independent prognostic variables.

Conclusions: A comprehensive CMR assessment is useful for stratifying risk soon after STEMI, but only the extent of systolic dysfunction and of transmural necrosis provide independent prognostic information.
Key Words: cardiac magnetic resonance • myocardial infarction • prognosis.

Am Coll Cardiol Img, 2009; 2:835-842.