Key result
Contrast-enhanced steady-state free precession CMR showed high correlation (r=0.83) and low bias (1.1%) compared with the BARI angiographic score for quantifying myocardium at risk following STEMI.
Why the study?
Does CE-SSFP CMR accurately quantify myocardium at risk compared to angiographic jeopardy scores in patients with STEMI?
Observational (n=78)
Single-blind
No
Does CE-SSFP CMR accurately quantify myocardium at risk compared to angiographic jeopardy scores in patients with STEMI?
Effect estimate: r=0.83 (95% CI -11.4 to 9.1)
p-value: p=<0.0001
CE-SSFP CMR is a reliable and practical method to quantify myocardium at risk following STEMI, showing high correlation and low bias compared with traditional angiographic scoring.
CE-SSFP CMR may support myocardium at risk quantification in STEMI; leaves open prospective outcome validation.
BACKGROUND: Clinical outcome following acute myocardial infarction is predicted by final infarct size evaluated in relation to left ventricular myocardium at risk (MaR). Contrast-enhanced steady-state free precession (CE-SSFP) cardiovascular magnetic resonance imaging (CMR) is not widely used for assessing MaR. Evidence of its utility compared to traditional assessment methods and as a surrogate for clinical outcome is needed. METHODS: Retrospective analysis within a study evaluating post-conditioning during ST elevation myocardial infarction (STEMI) treated with coronary intervention (n = 78). CE-SSFP post-infarction was compared with angiographic jeopardy methods. Differences and variability between CMR and angiographic methods using Bland-Altman analyses were evaluated. Clinical outcomes were compared to MaR and extent of infarction. RESULTS: MaR showed correlation between CE-SSFP, and both BARI and APPROACH scores of 0.83 (p < 0.0001) and 0.84 (p < 0.0001) respectively. Bias between CE-SSFP and BARI was 1.1% (agreement limits -11.4 to +9.1). Bias between CE-SSFP and APPROACH was 1.2% (agreement limits -13 to +10.5). Inter-observer variability for the BARI score was 0.56 ± 2.9; 0.42 ± 2.1 for the APPROACH score; -1.4 ± 3.1% for CE-SSFP. Intra-observer variability was 0.15 ± 1.85 for the BARI score; for the APPROACH score 0.19 ± 1.6; and for CE-SSFP -0.58 ± 2.9%. CONCLUSION: Quantification of MaR with CE-SSFP imaging following STEMI shows high correlation and low bias compared with angiographic scoring and supports its use as a reliable and practical method to determine myocardial salvage in this patient population. TRIAL REGISTRATION: January 2008.
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Palma et al. (2016) conducted an observational in ST-elevation myocardial infarction (STEMI) (n=78). Contrast-enhanced steady-state free precession (CE-SSFP) CMR vs. Angiographic jeopardy scores (BARI and modified APPROACH) was evaluated on Correlation and bias between CE-SSFP and BARI score for myocardium at risk (r=0.83, 95% CI -11.4 to 9.1, p=<0.0001). Contrast-enhanced steady-state free precession CMR showed high correlation (r=0.83) and low bias (1.1%) compared with the BARI angiographic score for quantifying myocardium at risk following STEMI.
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