Published online before print June 26, 2006, doi: 10.1161/CIRCULATIONAHA.106.613414
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(Circulation. 2006;114:32-39.)
© 2006 American Heart Association, Inc.
Imaging |
Characterization of the Peri-Infarct Zone by Contrast-Enhanced Cardiac Magnetic Resonance Imaging Is a Powerful Predictor of Post–Myocardial Infarction Mortality
From the Cardiovascular Magnetic Resonance Imaging Program (A.T.Y., A.J.S., C.W.C., T.M.L., R.Y.K.), Cardiovascular Division, Departments of Medicine and Radiology; the Cardiovascular Division (W.G.S.), Department of Medicine; and the Divisions of Nuclear Medicine/PET and Cardiovascular Imaging (M.F.D.C.), Department of Radiology; Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass; the University of Vermont College of Medicine (K.A.B.), Medical Center Hospital of Vermont, Burlington; and Global Applied Science Laboratory (S.N.G., H.G.R.), General Electric Healthcare, Bethesda, Md.
Reprint requests to Raymond Y. Kwong, MD, MPH, Brigham and Women’s Hospital, Cardiovascular Division, Department of Medicine, 75 Francis St, Boston, MA 02115. E-mail rykwong{at}partners.org
Received January 18, 2006; revision received March 25, 2006; accepted April 24, 2006.
Background— Accurate risk stratification is crucial for effective treatment planning after myocardial infarction (MI). Previous studies suggest that the peri-infarct border zone may be an important arrhythmogenic substrate. In this pilot study, we tested the hypothesis that the extent of the peri-infarct zone quantified by contrast-enhanced cardiac magnetic resonance (CMR) is an independent predictor of post-MI mortality.
Methods and Results— We studied 144 patients with documented coronary artery disease and abnormal myocardial delayed enhancement (MDE) consistent with MI. A computer-assisted, semiautomatic algorithm quantified the total infarct size and divided it into the core and peri-infarct regions based on signal-intensity thresholds (>3 SDs and 2 to 3 SDs above remote normal myocardium, respectively). The peri-infarct zone was normalized as a percentage of the total infarct size (%MDEperiphery). After a median follow-up of 2.4 years, 29 (20%) patients died. Patients with an above-median %MDEperiphery were at higher risk for death compared with those with a below-median %MDEperiphery (28% versus 13%, log-rank P<0.01). Multivariable analysis showed that left ventricular systolic volume index and %MDEperiphery were the strongest predictors of all-cause mortality (adjusted hazard ratio [HR] for %MDEperiphery, 1.45 per 10% increase; P=0.002) and cardiovascular mortality (adjusted HR, 1.51 per 10% increase; P=0.009). Similarly, after adjusting for age and left ventricular ejection fraction, %MDEperiphery maintained strong and independent associations with all-cause mortality (adjusted HR, 1.42; P=0.005) and cardiovascular mortality (adjusted HR, 1.49; P=0.01).
Conclusions— In patients with a prior MI, the extent of the peri-infarct zone characterized by CMR provides incremental prognostic value beyond left ventricular systolic volume index or ejection fraction. Infarct characteristics by CMR may prove to be a unique and valuable noninvasive predictor of post-MI mortality.
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