Relationship of Myocardial Strain and Markers of Myocardial Injury to Predict Segmental Recovery After Acute ST-Segment-Elevation Myocardial Infarction.
BACKGROUND
Late gadolinium-enhanced cardiovascular magnetic resonance imaging overestimates infarct size and underestimates recovery of dysfunctional segments acutely post ST-segment-elevation myocardial infarction. We assessed whether cardiovascular magnetic resonance imaging-derived segmental myocardial strain and markers of myocardial injury could improve the accuracy of late gadolinium-enhancement in predicting functional recovery after ST-segment-elevation myocardial infarction.


RESULTS
A total of 164 ST-segment-elevation myocardial infarction patients underwent acute (median 3 days) and follow-up (median 9.4 months) cardiovascular magnetic resonance imaging. Wall-motion scoring, feature tracking-derived circumferential strain (Ecc), segmental area of late gadolinium-enhancement (SEE), microvascular obstruction, intramyocardial hemorrhage, and salvage index (MSI) were assessed in 2624 segments. We used logistic regression analysis to identify markers that predict segmental recovery. At acute CMR 32% of segments were dysfunctional, and at follow-up CMR 19% were dysfunctional. Segmental function at acute imaging and odds ratio (OR) for functional recovery decreased with increasing SEE, although 33% of dysfunctional segments with SEE 76% to 100% improved. SEE was a strong predictor of functional improvement and normalization (area under the curve [AUC], 0.840 [95% confidence interval {CI}, 0.814-0.867]; OR, 0.97 [95% CI, 0.97-0.98] per +1% SEE for improvement and AUC, 0.887 [95% CI, 0.865-0.909]; OR, 0.95 [95% CI, 0.94-0.96] per +1% SEE for normalization). Its predictive accuracy for improvement, as assessed by areas under the receiver operator curves, was similar to that of MSI (AUC, 0.840 [95% CI, 0.809-0.872]; OR, 1.03 [95% CI, 1.02-1.03] per +1% MSI for improvement and AUC, 0.862 [0.832-0.891]; OR, 1.04 [95% CI, 1.03-1.04] per +1% SEE for normalization) and Ecc (AUC, 0.834 [95% CI, 0.807-0.862]; OR, 1.05 [95% CI, 1.03-1.07] per +1% MSI for improvement and AUC, 0.844 [95% CI, 0.818-0.871]; OR, 1.07 [95% CI, 1.05-1.10] per +1% SEE for normalization), and for normalization was greater than the other predictors. MSI and Ecc remained as significant after adjustment for SEE but provided no significant increase in predictive accuracy for improvement and normalization compared with SEE alone. MSI had similar predictive accuracy to SEE for functional recovery but was not assessable in 25% of patients. Microvascular obstruction provided no incremental predictive accuracy above SEE.


CONCLUSIONS
This multicenter study confirms that SEE is a strong predictor of functional improvement post ST-segment-elevation myocardial infarction, but recovery occurs in a substantial proportion of dysfunctional segments with SEE >75%. Feature tracking-derived Ecc and MSI provide minimal incremental benefit to SEE in predicting segmental recovery.


BACKGROUND
URL: http://www.isrctn.com. Unique identifier: ISRCTN70913605.
From the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular BRU, Glenfield Hospital, United Kingdom (J.N.K., S.A.N., A.Singh, A.Shetye, F.Y.L., G.P.M.); Department of Cardiology, University Hospital Southampton NHS Trust, United Kingdom (C.P.); Department of Cardiology, Royal Brompton and Harefield NHS Trust, London, United Kingdom (J.W.); and The Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, United Kingdom (J.P.G.).
Jamal N
JN
Khan
From the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular BRU, Glenfield Hospital, United Kingdom (J.N.K., S.A.N., A.Singh, A.Shetye, F.Y.L., G.P.M.); Department of Cardiology, University Hospital Southampton NHS Trust, United Kingdom (C.P.); Department of Cardiology, Royal Brompton and Harefield NHS Trust, London, United Kingdom (J.W.); and The Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, United Kingdom (J.P.G.).
Sheraz A
SA
Nazir
From the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular BRU, Glenfield Hospital, United Kingdom (J.N.K., S.A.N., A.Singh, A.Shetye, F.Y.L., G.P.M.); Department of Cardiology, University Hospital Southampton NHS Trust, United Kingdom (C.P.); Department of Cardiology, Royal Brompton and Harefield NHS Trust, London, United Kingdom (J.W.); and The Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, United Kingdom (J.P.G.).
Anvesha
A
Singh
From the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular BRU, Glenfield Hospital, United Kingdom (J.N.K., S.A.N., A.Singh, A.Shetye, F.Y.L., G.P.M.); Department of Cardiology, University Hospital Southampton NHS Trust, United Kingdom (C.P.); Department of Cardiology, Royal Brompton and Harefield NHS Trust, London, United Kingdom (J.W.); and The Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, United Kingdom (J.P.G.).
Abhishek
A
Shetye
From the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular BRU, Glenfield Hospital, United Kingdom (J.N.K., S.A.N., A.Singh, A.Shetye, F.Y.L., G.P.M.); Department of Cardiology, University Hospital Southampton NHS Trust, United Kingdom (C.P.); Department of Cardiology, Royal Brompton and Harefield NHS Trust, London, United Kingdom (J.W.); and The Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, United Kingdom (J.P.G.).
Florence Y
FY
Lai
From the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular BRU, Glenfield Hospital, United Kingdom (J.N.K., S.A.N., A.Singh, A.Shetye, F.Y.L., G.P.M.); Department of Cardiology, University Hospital Southampton NHS Trust, United Kingdom (C.P.); Department of Cardiology, Royal Brompton and Harefield NHS Trust, London, United Kingdom (J.W.); and The Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, United Kingdom (J.P.G.).
Charles
C
Peebles
From the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular BRU, Glenfield Hospital, United Kingdom (J.N.K., S.A.N., A.Singh, A.Shetye, F.Y.L., G.P.M.); Department of Cardiology, University Hospital Southampton NHS Trust, United Kingdom (C.P.); Department of Cardiology, Royal Brompton and Harefield NHS Trust, London, United Kingdom (J.W.); and The Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, United Kingdom (J.P.G.).
Joyce
J
Wong
From the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular BRU, Glenfield Hospital, United Kingdom (J.N.K., S.A.N., A.Singh, A.Shetye, F.Y.L., G.P.M.); Department of Cardiology, University Hospital Southampton NHS Trust, United Kingdom (C.P.); Department of Cardiology, Royal Brompton and Harefield NHS Trust, London, United Kingdom (J.W.); and The Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, United Kingdom (J.P.G.).
John P
JP
Greenwood
From the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular BRU, Glenfield Hospital, United Kingdom (J.N.K., S.A.N., A.Singh, A.Shetye, F.Y.L., G.P.M.); Department of Cardiology, University Hospital Southampton NHS Trust, United Kingdom (C.P.); Department of Cardiology, Royal Brompton and Harefield NHS Trust, London, United Kingdom (J.W.); and The Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, United Kingdom (J.P.G.). Gerry.McCann@uhl-tr.nhs.uk.
Gerry P
GP
McCann
D000368:Aged; D019540:Area Under Curve; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D006801:Humans; D016015:Logistic Models; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D009204:Myocardial Revascularization; D009206:Myocardium / Q000473:pathology*; D009336:Necrosis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D020127:Recovery of Function; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D013314:Stress, Mechanical; D013997:Time Factors; D014022:Tissue Survival; D006113:United Kingdom
D003287:Contrast Media
late gadolinium enhancement; magnetic resonance imaging; myocardial infarction; myocardial viability; strain