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Erschienen in: The International Journal of Cardiovascular Imaging 4/2013

01.04.2013 | Original Paper

Impact of transmural necrosis on left ventricular remodeling and clinical outcomes in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction

verfasst von: Kye Taek Ahn, Young Bin Song, Yeon Hyeon Choe, Jeong Hoon Yang, Joo-Yong Hahn, Jin-Ho Choi, Seung-Hyuk Choi, Sung-A Chang, Sang-Chol Lee, Sang Hoon Lee, Jae K. Oh, Hyeon-Cheol Gwon

Erschienen in: The International Journal of Cardiovascular Imaging | Ausgabe 4/2013

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Abstract

We sought to determine which contrast-enhanced magnetic resonance imaging (CE-MRI) parameter is the best predictor for left ventricular (LV) remodeling and clinical outcomes after ST-segment elevation myocardial infarction (STEMI). In 135 patients undergoing primary percutaneous coronary intervention (PCI) for STEMI, CE-MRI was performed at a median of 7 days after PCI. Echocardiography was performed soon after PCI and at a follow-up visit. LV remodeling was defined as an increase in end-diastolic volume index ≥20 % on follow-up echocardiography. Several CE-MRI parameters such as infarct size, transmurality, microvascular obstruction (MVO), and hemorrhagic infarction were tested using a 17-myocardial segment model. Optimal cut-off values were derived from receiver-operating characteristic curve (ROC) analysis. Twenty-eight patients (21 %) demonstrated LV remodeling. Although the addition of transmural necrotic segment count, infarct size, and MVO segment count to clinical models improved the prediction of LV remodeling in multivariable regression analysis, transmural necrotic segment count had better incremental predictive value than other CE-MRI parameters. The aggregate consideration of infarct size (cut-off ≥25 %), transmural necrotic segment count (≥5), and MVO segment count (≥2) yielded better diagnostic performance than each of the individual parameters in ROC analysis (P < 0.01). In Kaplan–Meier curve analysis, patients with transmural necrotic segment counts ≥5 had a higher incidence of major adverse cardiac event than did those without. The transmural necrotic segment count is the most important predictor of LV remodeling and clinical outcomes. The combination of CE-MRI parameters including infarct size, transmural necrotic segment count, and MVO segment count appeared to increase reliability for predicting LV remodeling.
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Metadaten
Titel
Impact of transmural necrosis on left ventricular remodeling and clinical outcomes in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction
verfasst von
Kye Taek Ahn
Young Bin Song
Yeon Hyeon Choe
Jeong Hoon Yang
Joo-Yong Hahn
Jin-Ho Choi
Seung-Hyuk Choi
Sung-A Chang
Sang-Chol Lee
Sang Hoon Lee
Jae K. Oh
Hyeon-Cheol Gwon
Publikationsdatum
01.04.2013
Verlag
Springer Netherlands
Erschienen in
The International Journal of Cardiovascular Imaging / Ausgabe 4/2013
Print ISSN: 1569-5794
Elektronische ISSN: 1875-8312
DOI
https://doi.org/10.1007/s10554-012-0155-9

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