title: A comparison of infarct mass by cardiac magnetic resonance and real time myocardial perfusion echocardiography as predictors of major adverse cardiac events following reperfusion for ST elevation myocardial infarction.
abstract: OBJECTIVE
  Infarct mass as assessed by myocardial-delayed enhancement imaging on cardiac magnetic resonance (CMR) and myocardial blood flow as assessed by real time myocardial perfusion echocardiography (RT-MPE) have been shown to predict adverse events following ST elevation myocardial infarction (STEMI). There has been no published comparison of quantitative assessment using these modalities as predictors of clinical outcomes to date. We compared RT-MPE with CMR for prediction of cardiac events in reperfused STEMI patients.
  
  
  METHODS
  Consecutive STEMI patients with early reperfusion were studied. RT-MPE and CMR were performed. Perfusion score indices (PSIRT-MPEand PSICMR) were calculated [sum of segmental perfusion scores/number of segments]. CMR infarct mass (g) and RT-MPE myocardial blood flow (MBF dB/s) were quantified. Patients were followed for cardiac events (death, nonfatal MI, revascularization, angina, and heart failure).
  
  
  RESULTS
  All 27 patients (age 62±14; follow-up 3.5±2.6 years) had thrombolysis in myocardial infarction (TIMI) grade 3 flow of infarct vessel. Cardiac events occurred in 17 (63%). Cardiac event patients had higher PSIRT-MPE, PSICMR, infarct mass, and lower MBF. PSIRT-MPEcutoff of 0.3 had an AUC of 0.856 (82% sensitivity, 70% specificity), while a PSICMRcutoff of 0.2 had an AUC of 0.765 (76% sensitivity, 60% specificity). Infarct mass and MBF were independent predictors of cardiac events after adjusting for risk factors (hazard ratios: 20.9 [95% CI 1.8-256] P=.02 and 8.1 [95% CI 1.5-78] P=.01, respectively).
  
  
  CONCLUSIONS
  Quantitative RT-MPE performed comparably to CMR for prediction of MACE in STEMI patients supporting a prognostic role for this noninvasive, bedside imaging method.
authors.affiliation: Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, Minnesota.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Lenz
authors.affiliation: Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, Minnesota.
authors.forename: Sahar S
authors.initials: SS
authors.lastname: Abdelmoneim
authors.affiliation: Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, Minnesota.|Department of Radiology, Mayo Clinic Rochester, Rochester, Minnesota.
authors.forename: Nandan S
authors.initials: NS
authors.lastname: Anavekar
authors.affiliation: Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, Minnesota.|Department of Radiology, Mayo Clinic Rochester, Rochester, Minnesota.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Foley
authors.affiliation: Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, Minnesota.
authors.forename: Lara F
authors.initials: LF
authors.lastname: Nhola
authors.affiliation: Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, Minnesota.
authors.forename: Runqing
authors.initials: R
authors.lastname: Huang
authors.affiliation: Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, Minnesota.
authors.forename: Jae K
authors.initials: JK
authors.lastname: Oh
authors.affiliation: Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, Minnesota. smulvagh@mayo.edu.
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Mulvagh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D009204:Myocardial Revascularization / Q000401:mortality*; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015996:Survival Rate; D016896:Treatment Outcome
keywords: ST elevation myocardial infarction; major adverse cardiac events; microvascular obstruction; outcomes research; perfusion imaging; prognosis