Long-term prognostic value of a comprehensive assessment of cardiac magnetic resonance indexes after an ST-segment elevation myocardial infarction.
OBJECTIVE
A variety of cardiac magnetic resonance indexes predict mid-term prognosis in ST-segment elevation myocardial infarction patients. The extent of transmural necrosis permits simple and accurate prediction of systolic recovery. However, its long-term prognostic value beyond a comprehensive clinical and cardiac magnetic resonance evaluation is unknown. We hypothesized that a simple semiquantitative assessment of the extent of transmural necrosis is the best resonance index to predict long-term outcome soon after a first ST-segment elevation myocardial infarction.


METHODS
One week after a first ST-segment elevation myocardial infarction we carried out a comprehensive quantification of several resonance parameters in 206 consecutive patients. A semiquantitative assessment (altered number of segments in the 17-segment model) of edema, baseline and post-dobutamine wall motion abnormalities, first pass perfusion, microvascular obstruction, and the extent of transmural necrosis was also performed.


RESULTS
During follow-up (median 51 months), 29 patients suffered a major adverse cardiac event (8 cardiac deaths, 11 nonfatal myocardial infarctions, and 10 readmissions for heart failure). Major cardiac events were associated with more severely altered quantitative and semiquantitative resonance indexes. After a comprehensive multivariate adjustment, the extent of transmural necrosis was the only resonance index independently related to the major cardiac event rate (hazard ratio=1.34 [1.19-1.51] per each additional segment displaying>50% transmural necrosis, P<.001).


CONCLUSIONS
A simple and non-time consuming semiquantitative analysis of the extent of transmural necrosis is the most powerful cardiac magnetic resonance index to predict long-term outcome soon after a first ST-segment elevation myocardial infarction.
Servicio de Cardiología, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Valencia, Spain.
Pilar
P
Merlos
Unidad de Resonancia Magnética Cardiaca, ERESA, Valencia, Spain.
Maria P
MP
López-Lereu
Unidad de Resonancia Magnética Cardiaca, ERESA, Valencia, Spain.
Jose V
JV
Monmeneu
Servicio de Cardiología, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Valencia, Spain.
Juan
J
Sanchis
Servicio de Cardiología, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Valencia, Spain.
Julio
J
Núñez
Servicio de Cardiología, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Valencia, Spain.
Clara
C
Bonanad
Servicio de Cardiología, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Valencia, Spain.
Ernesto
E
Valero
Servicio de Cardiología, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Valencia, Spain.
Gema
G
Miñana
Centro de Biomateriales e Ingeniería Tisular, Universidad Politécnica de Valencia, Valencia, Spain.
Fabián
F
Chaustre
Servicio de Cardiología, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Valencia, Spain.
Cristina
C
Gómez
Unidad de Cuidados Intensivos, Hospital Clínico Universitario, Valencia, Spain.
Ricardo
R
Oltra
Unidad de Cuidados Intensivos, Hospital Clínico Universitario, Valencia, Spain.
Lorena
L
Palacios
Unidad de Cardiología, Hospital de La Plana, Villarreal, Castellón, Spain.
Maria J
MJ
Bosch
Servicio de Radiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
Vicente
V
Navarro
Servicio de Cardiología, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Valencia, Spain.
Angel
A
Llácer
Servicio de Cardiología, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Valencia, Spain.
Francisco J
FJ
Chorro
Servicio de Cardiología, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Valencia, Spain. Electronic address: vicentbodi@hotmail.com.
Vicente
V
Bodí
D000368:Aged; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D009336:Necrosis; D011237:Predictive Value of Tests; D011379:Prognosis; D016896:Treatment Outcome
CMR; Cardiac magnetic resonance; ETN; Extensión de la necrosis transmural; Extent of transmural necrosis; Infarto agudo de miocardio con elevación del segmento ST; LVEF; MACE; Prognosis; Pronóstico; Resonancia magnética cardiaca; ST-segment elevation myocardial infarction; STEMI; WMA; cardiac magnetic resonance; extent of transmural necrosis; left ventricular ejection fraction; major cardiovascular events; wall motion abnormalities