title: Scar extent, left ventricular end-diastolic volume, and wall motion abnormalities identify high-risk patients with previous myocardial infarction: a multiparametric approach for prognostic stratification.
abstract: OBJECTIVE
  We sought to investigate whether combining left ventricular (LV) volumes, regional wall motion abnormalities, and scar tissue extent obtained by cardiac magnetic resonance (CMR) improves risk stratification of patients with previous myocardial infarction (MI).
  
  
  RESULTS
  In 231 consecutive patients (age 64 ± 11 years, males 89%) with previous MI, we quantified LV volumes and regional wall motion abnormalities by cine CMR, and measured the extent of the infarction scar by late gadolinium enhancement (LGE). During follow-up (median, 3.2 years) cardiac events (cardiac death or appropriate intra-cardiac defibrillator shocks) occurred in 19 patients. After adjustment for age, an extent of LGE >12.7%, an LV end-diastolic volume >105 mL/m(2), and a wall motion score index >1.7 were independent associated with adverse cardiac events at multivariate analysis (P < 0.05, P < 0.001, and P < 0.01, respectively). The patients with none of these factors, and those with one or two factors, showed a lower risk of cardiac events [hazard ratio (HR) = 0.112, P < 0.01 and HR = 0.261, P < 0.05] than those with three factors. The cumulative event-rate estimated at 4 years was 29.6% in patients with all three factors, 7.7% in those with one or two factors, and 3.5% in patients with none of these factors.
  
  
  CONCLUSIONS
  A multiparametric CMR approach, which includes the measure of scar tissue extent, LV end-diastolic volume and regional wall motion abnormalities, improves risk stratification of patients with previous MI.
authors.affiliation: CNR,  Institute of Clinical Physiology, G. Monasterio Foundation, Via Moruzzi, 1, 56124, Pisa,  Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Di Bella
authors.forename: Valeria
authors.initials: V
authors.lastname: Siciliano
authors.forename: Giovanni Donato
authors.initials: GD
authors.lastname: Aquaro
authors.forename: Sabrina
authors.initials: S
authors.lastname: Molinaro
authors.forename: Massimo
authors.initials: M
authors.lastname: Lombardi
authors.forename: Scipione
authors.initials: S
authors.lastname: Carerj
authors.forename: Patrizia
authors.initials: P
authors.lastname: Landi
authors.forename: Daniele
authors.initials: D
authors.lastname: Rovai
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pingitore
mesh_terms: D002921:Cicatrix / Q000473:pathology*; D016757:Death, Sudden, Cardiac / Q000209:etiology; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000473:pathology / Q000503:physiopathology / Q000517:prevention & control; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention; D013318:Stroke Volume / Q000502:physiology*