title: Impact of transmural necrosis on left ventricular remodeling and clinical outcomes in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction.
abstract: We sought to determine which contrast-enhanced magnetic resonance imaging (CE-MRI) parameter is the best predictor for left ventricular (LV) remodeling and clinical outcomes after ST-segment elevation myocardial infarction (STEMI). In 135 patients undergoing primary percutaneous coronary intervention (PCI) for STEMI, CE-MRI was performed at a median of 7 days after PCI. Echocardiography was performed soon after PCI and at a follow-up visit. LV remodeling was defined as an increase in end-diastolic volume index ≥20 % on follow-up echocardiography. Several CE-MRI parameters such as infarct size, transmurality, microvascular obstruction (MVO), and hemorrhagic infarction were tested using a 17-myocardial segment model. Optimal cut-off values were derived from receiver-operating characteristic curve (ROC) analysis. Twenty-eight patients (21 %) demonstrated LV remodeling. Although the addition of transmural necrotic segment count, infarct size, and MVO segment count to clinical models improved the prediction of LV remodeling in multivariable regression analysis, transmural necrotic segment count had better incremental predictive value than other CE-MRI parameters. The aggregate consideration of infarct size (cut-off ≥25 %), transmural necrotic segment count (≥5), and MVO segment count (≥2) yielded better diagnostic performance than each of the individual parameters in ROC analysis (P < 0.01). In Kaplan-Meier curve analysis, patients with transmural necrotic segment counts ≥5 had a higher incidence of major adverse cardiac event than did those without. The transmural necrotic segment count is the most important predictor of LV remodeling and clinical outcomes. The combination of CE-MRI parameters including infarct size, transmural necrotic segment count, and MVO segment count appeared to increase reliability for predicting LV remodeling.
authors.affiliation: Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, #50, Irwon-dong, Gangnam-gu, Seoul 135-710, Republic of Korea.
authors.forename: Kye Taek
authors.initials: KT
authors.lastname: Ahn
authors.forename: Young Bin
authors.initials: YB
authors.lastname: Song
authors.forename: Yeon Hyeon
authors.initials: YH
authors.lastname: Choe
authors.forename: Jeong Hoon
authors.initials: JH
authors.lastname: Yang
authors.forename: Joo-Yong
authors.initials: JY
authors.lastname: Hahn
authors.forename: Jin-Ho
authors.initials: JH
authors.lastname: Choi
authors.forename: Seung-Hyuk
authors.initials: SH
authors.lastname: Choi
authors.forename: Sung-A
authors.initials: SA
authors.lastname: Chang
authors.forename: Sang-Chol
authors.initials: SC
authors.lastname: Lee
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Lee
authors.forename: Jae K
authors.initials: JK
authors.lastname: Oh
authors.forename: Hyeon-Cheol
authors.initials: HC
authors.lastname: Gwon
mesh_terms: D000368:Aged; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging; D018572:Disease-Free Survival; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D016015:Logistic Models; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D009206:Myocardium / Q000473:pathology*; D009336:Necrosis; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D012372:ROC Curve; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D020257:Ventricular Remodeling
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA