Acute myocardial infarction early viability assessment by 64-slice computed tomography immediately after coronary angiography: comparison with low-dose dobutamine echocardiography.
OBJECTIVE
Early evaluation of myocardial viability in acute myocardial infarction is useful to guide therapy. Therefore, we assessed 64-slice computed tomography (CT) immediately after coronary angiography in this setting.


BACKGROUND
Recent preliminary studies have shown the promising usefulness of late hyperenhancement multislice computed tomography (MSCT) for non-viability assessment.


METHODS
Thirty-six patients admitted for a first acute myocardial infarction had a coronary angiogram early after admission followed by 64-slice CT without iodine reinjection. The 16 segments of the left ventricle depicted by the American Society of Echocardiography were graded: no, subendocardial, or transmural hyperenhancement. No or subendocardial hyperenhancement were expected to reflect viability. Two to 4 weeks later, the same segments' contractility was evaluated at rest. Low-dose dobutamine echocardiography was performed in case of akinetic segment at rest.


RESULTS
Mean delay between coronary angiography and MSCT was 24 +/- 11 min (range 7 to 51 min). We compared 576 segments evaluated by each method. Agreement was noted for 560 segments (97%) and disagreement for 16 segments (3%). Thus, 64-slice CT after coronary angiography for an acute myocardial infarction had 98% sensitivity, 94% specificity, 97% accuracy, and 99% positive and 79% negative predictive values for detecting viable myocardial segments at a very early stage of an acute myocardial infarction. On a per-patient analysis, sensitivity, specificity, accuracy, and positive and negative predictive values were 92%, 100%, 94%, and 100% and 85%, respectively.


CONCLUSIONS
A 64-slice CT after coronary angiography for an acute myocardial infarction is a promising method for early evaluation of viable myocardium.
Habis
Michel
M
Department of Cardiology, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France. mhabis@ccml.fr
Capderou
André
A
Ghostine
Saïd
S
Daoud
Béatrice
B
Caussin
Christophe
C
Riou
Jean-Yves
JY
Brenot
Philippe
P
Angel
Claude Yves
CY
Lancelin
Bernard
B
Paul
Jean-François
JF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods; D004280:Dobutamine; D004305:Dose-Response Relationship, Drug; D015150:Echocardiography, Doppler / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000628:therapy; D011336:Probability; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D036542:Tomography, Spiral Computed / Q000379:methods*; D016277:Ventricular Function, Left / Q000502:physiology
D004280:Dobutamine