title: Three-dimensional MRI assessment of regional wall stress after acute myocardial infarction predicts postdischarge cardiac events.
abstract: OBJECTIVE
  To determine the prognostic significance of systolic wall stress (SWS) after reperfused acute myocardial infarction (AMI) using MRI.
  
  
  METHODS
  A total of 105 patients underwent MRI 7.8 +/- 4.2 days after AMI reperfusion. SWS was calculated by using a three-dimensional (3D) MRI approach to left ventricular (LV) wall thickness and to the radius of curvature. Between hospital discharge and the end of follow-up, an average of 4.1 +/- 1.7 years after AMI, 19 patients experienced a major cardiac event, including cardiac death, nonfatal reinfarction or heart failure (18.3%).
  
  
  RESULTS
  The results were mainly driven by heart failure outcome. In univariate analysis the following factors were predictive of postdischarge major adverse cardiac events: 1) at the time of AMI: higher heart rate, previous calcium antagonist treatment, in-hospital congestive heart failure, proximal left anterior descending artery (LAD) occlusion, a lower ejection fraction, higher maximal ST segment elevation before reperfusion, and ST segment reduction lower than 50% after reperfusion; 2) MRI parameters: higher LV end-systolic volume, lower ejection fraction, higher global SWS, higher SWS in the infarcted area (SWS MI) and higher SWS in the remote myocardium (SWS remote). In the final multivariate model, only SWS MI (odds ratio [OR]: 1.62; 95% confidence interval [CI]: 1.01-2.60; P = 0.046) and SWS remote (OR: 2.17; 95% CI: 1.02-4.65; P = 0.046) were independent predictors.
  
  
  CONCLUSIONS
  Regional SWS assessed by means of MRI a few days after AMI appears to be strong predictor of postdischarge cardiac events, identifying a subset of at risk patients who could qualify for more aggressive management.
authors.affiliation: Department of Cardiology, University Hospital of Angers, Angers, France. faprunier@chu-angers.fr
authors.forename: Fabrice
authors.initials: F
authors.lastname: Prunier
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Brette
authors.forename: Stéphane
authors.initials: S
authors.lastname: Delépine
authors.forename: Philippe
authors.initials: P
authors.lastname: Geslin
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Le Jeune
authors.forename: Alain P
authors.initials: AP
authors.lastname: Furber
mesh_terms: D006328:Cardiac Catheterization; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology*; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications / Q000503:physiopathology*; D011379:Prognosis; D012008:Recurrence; D013314:Stress, Mechanical; D020257:Ventricular Remodeling / Q000502:physiology