Prognostic value of microvascular damage determined by cardiac magnetic resonance in non ST-segment elevation myocardial infarction: comparison between first-pass and late gadolinium-enhanced images.
OBJECTIVE
To compare 2 cardiac magnetic resonance (CMR) techniques for the evaluation of the prognostic significance of microvascular damage after non ST-segment elevation myocardial infarction (NSTEMI).


METHODS
CMR was performed at 3T in 61 patients within the week following their first NSTEMI. A first-pass saturation-recovery gradient-echo perfusion sequence was started during the infusion of contrast material to evaluate the extent of microvascular obstruction (MO) during the first 2 minutes after injection (MO(<2 min)) and between 3 and 5 minutes thereafter (MO(3 min), MO(4 min), MO(5 min)). Ten minutes after injection, late gadolinium-enhanced images were obtained using a phase sensitive inversion recovery sequence to assess persistent MO (PMO) and infarct size. Major adverse cardiac events (MACE) were collected at 1-year follow-up.


RESULTS
MO(<2 min) and PMO were found in 28 of 61 and 17 of 61 patients, respectively. About 15 patients had MACE at 1 year, including 4 cardiac deaths. In univariate logistic regression analysis, age (odds ratio [OR], 1.07, P = 0.020), infarct size (OR, 1.08, P = 0.020), multivessel disease (OR, 5.08, P = 0.011), end diastolic volume (OR, 1.04, P = 0.003), end systolic volume (OR, 1.03, P = 0.010), MO from < 2 to 5 minutes postinjection (P < 0.05) and PMO (OR, 18.33, P < 0.001) were significantly associated with the outcome. In multivariate analysis, only PMO remained an independent predictor of MACE.


CONCLUSIONS
Microvascular damage assessed by CMR is associated with a dramatically higher risk of cardiovascular events in NSTEMI patients. Moreover, our data suggest that PMO as assessed on late gadolinium-enhanced images might have a higher prognostic value than MO evaluated on first-pass images.
Cochet
Alexandre
A
MRI Unit, University Hospital, Boulevard du Maréchal de Lattre de Tassigny, Dijon, France. alexandre.cochet@yahoo.fr
Lalande
Alain
A
Lorgis
Luc
L
Zeller
Marianne
M
Beer
Jean-Claude
JC
Walker
Paul M
PM
Touzery
Claude
C
Wolf
Jean-Eric
JE
Cottin
Yves
Y
Brunotte
François
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D005260:Female; D005682:Gadolinium; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D019028:Magnetic Resonance Imaging, Cine / Q000295:instrumentation* / Q000379:methods; D008297:Male; D055806:Microvessels / Q000473:pathology*; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D016017:Odds Ratio; D011379:Prognosis; D011877:Radionuclide Imaging; D018709:Statistics, Nonparametric; D013997:Time Factors
D005682:Gadolinium