title: Cardiac magnetic resonance imaging: infarct size is an independent predictor of mortality in patients with coronary artery disease.
abstract: BACKGROUND
  Cardiac magnetic resonance imaging (CMR) can accurately determine infarct size. Prior studies using indirect methods to assess infarct size have shown that patients with larger myocardial infarctions have a worse prognosis than those with smaller myocardial infarctions.
  
  
  OBJECTIVE
  This study assessed the prognostic significance of infarct size determined by CMR.
  
  
  METHODS
  Cine and contrast CMR were performed in 100 patients with coronary artery disease (CAD) undergoing routine cardiac evaluation. Infarct size was determined by planimetry. We used Cox proportional hazards regression analyses (stepwise forward selection approach) to evaluate the risk of all-cause death associated with traditional cardiovascular risk factors, symptoms of heart failure, medication use, left ventricular ejection fraction, left ventricular mass, angiographic severity of CAD and extent of infarct size determined by CMR.
  
  
  RESULTS
  Ninety-one patients had evidence of myocardial infarction by CMR. Mean follow-up was 4.8±1.6 years after CMR, during which time 30 patients died. The significant multivariable predictors of all-cause mortality were extent of myocardial infarction by CMR, extent of left ventricular systolic dysfunction, symptoms of heart failure, and diabetes mellitus (P<.05). The presence of infarct greater than or equal to 24% of left ventricular mass and left ventricular ejection fraction less than or equal to 30% were the most optimal cut-off points for the prediction of death with bivariate adjusted hazard ratios of 2.11 (95% confidence interval 1.02-4.38) and 4.06 (95% confidence interval 1.73-9.54), respectively.
  
  
  CONCLUSIONS
  The extent of myocardial infarction determined by CMR is an independent predictor of death in patients with CAD.
authors.affiliation: Division of Cardiology, Orlando Regional Medical Center, Orlando, FL 32806, USA. David.Bello@orlandohealth.com
authors.forename: David
authors.initials: D
authors.lastname: Bello
authors.forename: Arnold
authors.initials: A
authors.lastname: Einhorn
authors.forename: Rishi
authors.initials: R
authors.lastname: Kaushal
authors.forename: Satish
authors.initials: S
authors.lastname: Kenchaiah
authors.forename: Aidan
authors.initials: A
authors.lastname: Raney
authors.forename: David
authors.initials: D
authors.lastname: Fieno
authors.forename: Jagat
authors.initials: J
authors.lastname: Narula
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Goldberger
authors.forename: Kalyanam
authors.initials: K
authors.lastname: Shivkumar
authors.forename: Haris
authors.initials: H
authors.lastname: Subacius
authors.forename: Alan
authors.initials: A
authors.lastname: Kadish
mesh_terms: D000368:Aged; D002140:California / Q000453:epidemiology; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000378:metabolism* / Q000473:pathology*; D005260:Female; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000706:statistics & numerical data*; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality* / Q000473:pathology*; D015995:Prevalence; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate