Multidetector computed tomography predictors of late ventricular remodeling and function after acute myocardial infarction.
BACKGROUND
Despite advent of rapid arterial revascularization as 1st line treatment for acute myocardial infarction (AMI), incomplete restoral of flow at the microvascular level remains a problem and is associated with adverse prognosis, including pathological ventricular remodeling. We aimed to study the association between multidetector row computed tomography (MDCT) perfusion defects and ventricular remodeling post-AMI.


METHODS
In a prospective study, 20 patients with ST-elevation AMI, treated by primary angioplasty, underwent arterial and late phase MDCT as well as radionuclide scans to study presence, size and severity of myocardial perfusion defects. Contrast echocardiography was performed at baseline and at 4 months follow-up to evaluate changes in myocardial function and remodeling.


RESULTS
Early defects (ED), late defects (LD) and late enhancement (LE) were detected in 15, 7 and 16 patients, respectively and radionuclide defects in 15 patients. The ED area (r=0.74), and LD area (r=0.72), and to a lesser extent LE area (r=0.62) correlated moderately well with SPECT summed rest score. By univariate analysis, follow-up end-systolic volume index and ejection fraction were both significantly related to ED and LD size and severity, but not to LE size or severity. By multivariate analysis, end-systolic volume index was best predicted by LD area (p<0.05) and ejection fraction by LD enhancement ratio.


CONCLUSIONS
LD size and severity on MDCT are most closely associated with pathological ventricular remodeling after AMI and may thus play a role in early identification and treatment of this condition.
Cardiology Department, Rambam Health Care Campus, Haaliya Street, Haifa, Israel; Technion-IIT, Haaliya Street, Haifa, Israel. j lessick@rambam.health.gov.il
Jonathan
J
Lessick
Sobhi
S
Abadi
Yoram
Y
Agmon
Zohar
Z
Keidar
Shemi
S
Carasso
Doron
D
Aronson
Eduard
E
Ghersin
Shmuel
S
Rispler
Anat
A
Sebbag
Ora
O
Israel
Haim
H
Hammerman
Ariel
A
Roguin
D055424:Cardiac-Gated Imaging Techniques / Q000379:methods; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging*; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology; D020257:Ventricular Remodeling