title: Analysis of post-infarction salvaged myocardium by cardiac magnetic resonance. Predictors and influence on adverse ventricular remodeling.
abstract: OBJECTIVE
  To evaluate by cardiovascular magnetic resonance those factors related to the amount of salvaged myocardium after a myocardial infarction and its value in predicting adverse ventricular remodeling.
  
  
  METHODS
  One hundred eighteen patients admitted for a first ST elevation myocardial infarction (primary angioplasty, 65 patients; a pharmacoinvasive strategy, 53 patients) underwent magnetic resonance (6 [5-8] days and 6 months; n=83). The myocardial salvage index was quantitatively assessed as the percentage of area at risk (T2-weighted sequences) not showing late enhancement.
  
  
  RESULTS
  Myocardial salvage index >31% (median) was associated with a shorter time to reperfusion (153 min vs 258 min), a lower rate of diabetes (12% vs 32%), shorter time to magnetic resonance, and better cardiovascular parameters (P<.05 for all analyses). There were no significant differences depending on the reperfusion method. In a logistic regression analysis, delayed reperfusion (odds ratio=0.42 [0.29-0.63]; P<.0001), diabetes (odds ratio=0.32 [0.11-0.99]; P<.05) and a longer time to the performance of magnetic resonance (odds ratio=0.86 [0.76-0.97]; P<.05) were independently related to a lower probability of a myocardial salvage index >31%. Predictors of increased left ventricular end-systolic volume at 6 months were the number of segments showing an extent of transmural necrosis >50% (odds ratio =1.51 [1.21-1.90]; P<.0001) and left ventricular end-systolic volume at one week (odds ratio=1.12 [1.06-1.18]; P<.0001).
  
  
  CONCLUSIONS
  Cardiovascular magnetic resonance enables the quantification of the salvaged myocardium after myocardial infarction. The celerity with which reperfusion therapy is administered constitutes its most important predictor. The possible effect of a delay in the performance of magnetic resonance on myocardial salvage needs to be confirmed. Salvaged myocardium does not improve the value of magnetic resonance for predicting adverse remodeling.
authors.affiliation: Unidad de Imagen Cardiaca (ERESA), Hospital Clínico Universitario de Valencia, Avda. Blasco Ibáñez 17, Valencia, Spain. jmonmeneu@eresa.com
authors.forename: José V
authors.initials: JV
authors.lastname: Monmeneu
authors.forename: Vicente
authors.initials: V
authors.lastname: Bodí
authors.forename: María P
authors.initials: MP
authors.lastname: López-Lereu
authors.forename: Juan
authors.initials: J
authors.lastname: Sanchis
authors.forename: Julio
authors.initials: J
authors.lastname: Núñez
authors.forename: Fabián
authors.initials: F
authors.lastname: Chaustre
authors.forename: Oliver
authors.initials: O
authors.lastname: Husser
authors.forename: Pilar
authors.initials: P
authors.lastname: Merlos
authors.forename: Clara
authors.initials: C
authors.lastname: Bonanad
authors.forename: Gema
authors.initials: G
authors.lastname: Miñana
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Chorro
authors.forename: Angel
authors.initials: A
authors.lastname: Llácer
mesh_terms: D000368:Aged; D017130:Angioplasty; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D016015:Logistic Models; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D009206:Myocardium / Q000473:pathology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015424:Reperfusion; D012307:Risk Factors; D020257:Ventricular Remodeling / Q000502:physiology*