title: Characterization of the peri-infarct zone by contrast-enhanced cardiac magnetic resonance imaging is a powerful predictor of post-myocardial infarction mortality.
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.
  
  
  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 (%MDE(periphery)). After a median follow-up of 2.4 years, 29 (20%) patients died. Patients with an above-median %MDE(periphery) were at higher risk for death compared with those with a below-median %MDE(periphery) (28% versus 13%, log-rank P<0.01). Multivariable analysis showed that left ventricular systolic volume index and %MDE(periphery) were the strongest predictors of all-cause mortality (adjusted hazard ratio [HR] for %MDE(periphery), 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, %MDE(periphery) 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.
authors.affiliation: Cardiovascular Magnetic Resonance Imaging Program, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, Massachusetts 02115, USA.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Yan
authors.forename: Adolphe J
authors.initials: AJ
authors.lastname: Shayne
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Brown
authors.forename: Sandeep N
authors.initials: SN
authors.lastname: Gupta
authors.forename: Carmen W
authors.initials: CW
authors.lastname: Chan
authors.forename: Tuan M
authors.initials: TM
authors.lastname: Luu
authors.forename: Marcelo F
authors.initials: MF
authors.lastname: Di Carli
authors.forename: H Glenn
authors.initials: HG
authors.lastname: Reynolds
authors.forename: William G
authors.initials: WG
authors.lastname: Stevenson
authors.forename: Raymond Y
authors.initials: RY
authors.lastname: Kwong
mesh_terms: D000368:Aged; D003287:Contrast Media; D003324:Coronary Artery Disease / Q000150:complications; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality* / Q000473:pathology*; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D018487:Ventricular Dysfunction, Left / Q000209:etiology
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA