Sequelae of acute myocardial infarction regarding cardiac structure and function and their prognostic significance as assessed by magnetic resonance imaging

• Published in: European heart journal Vol. 26; no. 6; pp. 549 - 557
• Main Authors: Hombach, Vinzenz, Grebe, Olaf, Merkle, Nico, Waldenmaier, Sebastian, Höher, Martin, Kochs, Matthias, Wöhrle, Jochen, Kestler, Hans A.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01-03-2005; Oxford Publishing Limited (England)
• Subjects: Aged; Biological and medical sciences; Cardiac Catheterization; Cardiology. Vascular system; Coronary Angiography; Coronary heart disease; Disease-Free Survival; Female; Follow-Up Studies; Heart; Heart - physiopathology; Humans; Infarct size; Magnetic Resonance Imaging; Male; Medical sciences; Microvascular obstruction; Middle Aged; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - pathology; Myocardial Infarction - physiopathology; Myocardial viability; Myocarditis. Cardiomyopathies; Prognosis; Regression Analysis; Right ventricular infarction; Risk Factors; Ventricular Remodeling; Myocardial infarction; Cardiac performance; Prognosis; Acute; Size; Right ventricle; Microvascular obstruction; Cardiovascular disease; Sequela; Infarct size; Myocardial viability; Myocardial disease; Coronary heart disease; Nuclear magnetic resonance imaging; Obstruction; Microcirculation; Magnetic resonance imaging; Medical imagery; Right ventricular infarction; Structure; Viability
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehi147

Aims Because of its high spatial resolution and tissue contrast, magnetic resonance imaging (MRI) was used to assess cardiac structure and function in a large population of patients with acute myocardial infarction (AMI). Methods and results One hundred and ten patients were studied by MRI 6.1±2.2 days after AMI. Infarct size (IS), persistent microvascular obstruction (PMO), left and right ventricular (LV/RV) volumes, and functions were measured. The same MRI measurements were repeated in 89 patients after a mean follow-up period of 225±92 days. IS was 11.9±7.3% of total LV muscle mass. PMO was detected in 51/110 (46.4%) patients and comprised 15.6±8.5% of IS and 2.8±2.3% of LV muscle mass. Papillary muscle infarct was seen in 26%, RV infarction in 16%, pericarditis in 40%, and pericardial effusion in 66% of the patients. During follow-up, there were 16 major adverse cardiac events (MACE) including seven deaths. IS, PMO, and amount of transmural infarction were predictive for LV adverse remodelling defined as >20% increase in LV end-diastolic volume. Multivariable analysis revealed LV end-diastolic volume, LV ejection fraction, and PMO as significant predictors for the occurrence of MACE. Conclusion MRI is a highly sensitive and reliable tool to detect morphologic and functional sequelae of AMI providing baseline MRI parameters with relevant predictive power for LV adverse remodelling and occurrence of MACE.