title: Comparison of myocardial infarct size assessed with contrast-enhanced magnetic resonance imaging and left ventricular function and volumes to predict mortality in patients with healed myocardial infarction.
abstract: Currently, left ventricular (LV) ejection fraction (EF) and/or LV volumes are the established predictors of mortality in patients with coronary artery disease (CAD) and severe LV dysfunction. With contrast-enhanced magnetic resonance imaging (MRI), precise delineation of infarct size is now possible. The relative merits of LVEF/LV volumes and infarct size to predict long-term outcome are unknown. The purpose of this study was to determine the predictive value of infarct size assessed with contrast-enhanced MRI relative to LVEF and LV volumes for long-term survival in patients with healed myocardial infarction. Cine MRI and contrast-enhanced MRI were performed in 231 patients with healed myocardial infarction. LVEF and LV volumes were measured and infarct size was derived from contrast-enhanced MRI. Nineteen patients (8.2%) died during a median follow-up of 1.7 years (interquartile range 1.1 to 2.9). Cox proportional hazards analysis revealed that infarct size defined as spatial extent (hazard ratio [HR] 1.3, 95% confidence interval [CI] 1.1 to 1.6, chi-square 6.7, p=0.010), transmurality (HR 1.5, 95% CI 1.1 to 1.9, chi-square 8.9, p=0.003), or total scar score (HR 6.2, 95% CI 1.7 to 23, chi-square 7.4, p=0.006) were stronger predictors of all-cause mortality than LVEF and LV volumes. In conclusion, infarct size on contrast-enhanced MRI may be superior to LVEF and LV volumes for predicting long-term mortality in patients with healed myocardial infarction.
authors.affiliation: Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. s.d.roes@lumc.nl
authors.forename: Stijntje D
authors.initials: SD
authors.lastname: Roes
authors.forename: Sebastian
authors.initials: S
authors.lastname: Kelle
authors.forename: Theodorus A M
authors.initials: TA
authors.lastname: Kaandorp
authors.forename: Thomas
authors.initials: T
authors.lastname: Kokocinski
authors.forename: Don
authors.initials: D
authors.lastname: Poldermans
authors.forename: Hildo J
authors.initials: HJ
authors.lastname: Lamb
authors.forename: Eric
authors.initials: E
authors.lastname: Boersma
authors.forename: Ernst E
authors.initials: EE
authors.lastname: van der Wall
authors.forename: Eckart
authors.initials: E
authors.lastname: Fleck
authors.forename: Albert
authors.initials: A
authors.lastname: de Roos
authors.forename: Eike
authors.initials: E
authors.lastname: Nagel
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007089:Image Enhancement; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000473:pathology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D013318:Stroke Volume; D016019:Survival Analysis; D016277:Ventricular Function, Left