The extent of transmural necrosis was independently associated with time to MACEs (HR 1.38; 95% CI 1.19-1.60; P<0.001) and systolic recovery (OR 0.76; 95% CI 0.64-0.92; P=0.004) after STEMI.
Cohort (n=119)
Does the extent of transmural necrosis (ETN) predict MACEs and systolic recovery better than dobutamine-stress ejection fraction (EF(D)) in patients with a recent STEMI?
The extent of transmural necrosis assessed by cardiac MRI is an independent predictor of MACEs and systolic recovery after STEMI, performing as well as or better than dobutamine-stress ejection fraction.
Hazard Ratio: 1.38 (95% CI 1.19–1.6)
p-value: p=<.001
PURPOSE: To perform a comparison of cardiac magnetic resonance (MR) imaging-derived ejection fraction (EF) during low-dose dobutamine infusion (EF(D)) with the extent of segments with transmural necrosis in more than 50% of their wall thickness (ETN) for the prediction of major adverse cardiac events (MACEs) and late systolic recovery soon after a first ST-segment elevation myocardial infarction (STEMI). MATERIALS AND METHODS: Institutional ethics committee approval and written informed consent were obtained. One hundred nineteen consecutive patients with a first STEMI, a depressed left ventricular EF, and an open infarct-related artery underwent MR imaging at 1 week after infarction. EF(D) and ETN (by using a 17-segment model) were determined, and the prediction of MACEs and systolic recovery at follow-up was assessed by using area under the receiver operating characteristic curve (AUC) and multivariable regression analysis. RESULTS: During follow-up (median, 613 days; range, 312-1243 days), 18 MACEs (five cardiac deaths, six myocardial infarctions, seven readmissions for heart failure) occurred. MACEs were associated with a lower EF(D) (43% +/- 12 standard deviation vs 49% +/- 10, P = .02) and a larger ETN (seven segments +/- three vs four segments +/- three, P 5% at follow-up compared with baseline EF, n = 44) displayed a higher EF(D) (51% +/- 10 vs 47% +/- 9, P = .04) and a smaller ETN (three segments +/- two vs five segments +/- three, P = .002) at 1 week. ETN and EF(D) both related to MACEs (AUC: 0.78 vs 0.67, respectively, P = .1) and systolic recovery (AUC: 0.68 vs 0.62, respectively, P = .3). According to multivariable analysis, ETN was the only MR variable associated with time to MACEs (hazard ratio, 1.38; 95% confidence interval: 1.19, 1.60; P < .001) and systolic recovery (odds ratio, 0.76; 95% confidence interval: 0.64, 0.92; P = .004) independent of baseline characteristics. CONCLUSION: ETN is as useful as EF(D) for the prediction of MACEs and systolic recovery soon after STEMI.
Bodı́ et al. (Wed,) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=119). Extent of transmural necrosis (ETN) vs. Ejection fraction during low-dose dobutamine infusion (EF(D)) was evaluated on Time to major adverse cardiac events (MACEs) (HR 1.38, 95% CI 1.19-1.60, p=<.001). The extent of transmural necrosis was independently associated with time to MACEs (HR 1.38; 95% CI 1.19-1.60; P<0.001) and systolic recovery (OR 0.76; 95% CI 0.64-0.92; P=0.004) after STEMI.