title: CMR imaging for the evaluation of myocardial stunning after acute myocardial infarction: a meta-analysis of prospective trials.
abstract: BACKGROUND
  Myocardial stunning is an important sequela of acute coronary syndromes and its determination might affect decisions on defibrillator implantation and assist devices after myocardial infarction (AMI). The aim of the study was to evaluate and compare the sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of cardiac magnetic resonance imaging (CMR) assessing myocardial stunning after acute myocardial infarction using low-dose dobutamine (LDD), end-diastolic wall thickness, and contrast delayed enhancement (DE).
  
  
  RESULTS
  A systematic review of Medline, Embase, and Cochrane for all prospective trials assessing myocardial stunning by CMR following AMI was performed using a standard approach for meta-analysis for diagnostic test and a bivariate analysis. Search results revealed 9384 studies, out of which 17 met criteria. A total of 634 patients (mean age 59 years, 85% male, mean left ventricular ejection fraction: 52%) were included. DE-CMR had a weighted sensitivity of 87% and specificity of 68% to detect myocardial stunning using 50% transmurality as a cut-off, with a PPV and NPV of 83 and 72%, respectively. With an overall diagnostic accuracy of 82%, LDD-CMR had a sensitivity of 67% and a specificity of 81%, with a PPV and NPV of 82 and 63%, respectively. LDD showed an overall accuracy of 74%.
  
  
  CONCLUSIONS
  DE-CMR has a higher sensitivity, whereas LDD-CMR has a higher specificity for the detection of viable stunned myocardium following myocardial infarction. Whether the combination of DE and LDD may improve the prediction of myocardial recovery remains to be determined.
authors.affiliation: Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Silver Zone, Bronx, NY 10467-2400, USA.
authors.forename: Jorge
authors.initials: J
authors.lastname: Romero
authors.forename: Jonathan
authors.initials: J
authors.lastname: Kahan
authors.forename: Iosif
authors.initials: I
authors.lastname: Kelesidis
authors.forename: Harikrishna
authors.initials: H
authors.lastname: Makani
authors.forename: Omar
authors.initials: O
authors.lastname: Wever-Pinzon
authors.forename: Hector
authors.initials: H
authors.lastname: Medina
authors.forename: Mario J
authors.initials: MJ
authors.lastname: Garcia
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods / Q000401:mortality; D003287:Contrast Media; D001026:Coronary Artery Bypass / Q000379:methods / Q000401:mortality; D005080:Exercise Test / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D017682:Myocardial Stunning / Q000175:diagnosis* / Q000209:etiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011856:Radiographic Image Enhancement; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015996:Survival Rate
chemical_list: D003287:Contrast Media
keywords: Cardiac magnetic resonance imaging; Myocardial stunning; Myocardial viability; Revascularization