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01.12.2017 | Research | Ausgabe 1/2017 Open Access

Journal of Cardiovascular Magnetic Resonance 1/2017

Defining left ventricular remodeling following acute ST-segment elevation myocardial infarction using cardiovascular magnetic resonance

Zeitschrift:
Journal of Cardiovascular Magnetic Resonance > Ausgabe 1/2017
Autoren:
Heerajnarain Bulluck, Yun Yun Go, Gabriele Crimi, Andrew J. Ludman, Stefania Rosmini, Amna Abdel-Gadir, Anish N. Bhuva, Thomas A. Treibel, Marianna Fontana, Silvia Pica, Claudia Raineri, Alex Sirker, Anna S. Herrey, Charlotte Manisty, Ashley Groves, James C. Moon, Derek J. Hausenloy
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12968-017-0343-9) contains supplementary material, which is available to authorized users.

Abstract

Background

The assessment of post-myocardial infarction (MI) left ventricular (LV) remodeling by cardiovascular magnetic resonance (CMR) currently uses criteria defined by echocardiography. Our aim was to provide CMR criteria for assessing LV remodeling following acute MI.

Methods

Firstly, 40 reperfused ST-segment elevation myocardial infarction (STEMI) patients with paired acute (4 ± 2 days) and follow-up (5 ± 2 months) CMR scans were analyzed by 2 independent reviewers and the minimal detectable changes (MDCs) for percentage change in LV end-diastolic volume (%ΔLVEDV), LV end-systolic volume (%ΔLVESV), and LV ejection fraction (%ΔLVEF) between the acute and follow-up scans were determined. Secondly, in 146 reperfused STEMI patients, receiver operator characteristic curve analyses for predicting LVEF <50% at follow-up (as a surrogate for clinical poor clinical outcome) were undertaken to obtain cut-off values for %ΔLVEDV and %ΔLVESV.

Results

The MDCs for %ΔLVEDV, %ΔLVESV, and %ΔLVEF were similar at 12%, 12%, 13%, respectively. The cut-off values for predicting LVEF < 50% at follow-up were 11% for %ΔLVEDV on receiver operating characteristic curve analysis (area under the curve (AUC) 0.75, 95% CI 0.6 to 0.83, sensitivity 72% specificity 70%), and 5% for %ΔLVESV (AUC 0.83, 95% CI 0.77 to 0.90, sensitivity and specificity 78%). Using cut-off MDC values (higher than the clinically important cut-off values) of 12% for both %ΔLVEDV and %ΔLVESV, 4 main patterns of LV remodeling were identified in our cohort: reverse LV remodeling (LVEF predominantly improved); no LV remodeling (LVEF predominantly unchanged); adverse LV remodeling with compensation (LVEF predominantly improved); and adverse LV remodeling (LVEF unchanged or worsened).

Conclusions

The MDCs for %ΔLVEDV and %ΔLVESV between the acute and follow-up CMR scans of 12% each may be used to define adverse or reverse LV remodeling post-STEMI. The MDC for %ΔLVEF of 13%, relative to baseline, provides the minimal effect size required for investigating treatments aimed at improving LVEF following acute STEMI.
Zusatzmaterial
Additional file 1: Online appendix Table 1: CMR acquisition details of the 4 studies included. (DOCX 26 kb)
12968_2017_343_MOESM1_ESM.docx
Literatur
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