on June 26, 2006
Published online before print June 26, 2006, doi: 10.1161/CIRCULATIONAHA.106.613414
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Submitted on January 18, 2006
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. * To whom correspondence should be addressed. E-mail: rykwong{at}partners.org.
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.
Revised on March 25, 2006
Accepted on April 24, 2006
Characterization of the Peri-Infarct Zone by Contrast-Enhanced Cardiac Magnetic Resonance Imaging Is a Powerful Predictor of Post-Myocardial Infarction Mortality
Andrew T. Yan MD,
Key words: magnetic resonance imaging • myocardial infarction • prognosis
Related Article:
Circulation 2006 114: 1.
This article has been cited by other articles:
 |
|
 |
|
  K Rahimi, A P Banning, A S H Cheng, T J Pegg, T D Karamitsos, K M Channon, S Darby, D P Taggart, S Neubauer, and J B Selvanayagam Prognostic value of coronary revascularisation-related myocardial injury: a cardiac magnetic resonance imaging study Heart, December 1, 2009; 95(23): 1937 - 1943. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Y.C. Cheong, R. Muthupillai, J. M. Wilson, A. Sung, S. Huber, S. Amin, M. A. Elayda, V.-V. Lee, and S. D. Flamm Prognostic Significance of Delayed-Enhancement Magnetic Resonance Imaging: Survival of 857 Patients With and Without Left Ventricular Dysfunction Circulation, November 24, 2009; 120(21): 2069 - 2076. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Kelle, S. D. Roes, C. Klein, T. Kokocinski, A. de Roos, E. Fleck, J. J. Bax, and E. Nagel Prognostic value of myocardial infarct size and contractile reserve using magnetic resonance imaging. J. Am. Coll. Cardiol., November 3, 2009; 54(19): 1770 - 1777. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. D. Karamitsos, J. M. Francis, S. Myerson, J. B. Selvanayagam, and S. Neubauer The Role of Cardiovascular Magnetic Resonance Imaging in Heart Failure J. Am. Coll. Cardiol., October 6, 2009; 54(15): 1407 - 1424. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. J. Myerburg, V. Reddy, and A. Castellanos Indications for implantable cardioverter-defibrillators based on evidence and judgment. J. Am. Coll. Cardiol., August 25, 2009; 54(9): 747 - 763. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. M. Haqqani, J. M. Kalman, K. C. Roberts-Thomson, R. N. Balasubramaniam, R. Rosso, R. L. Snowdon, P. B. Sparks, J. K. Vohra, and J. B. Morton Fundamental Differences in Electrophysiologic and Electroanatomic Substrate Between Ischemic Cardiomyopathy Patients With and Without Clinical Ventricular Tachycardia J. Am. Coll. Cardiol., July 7, 2009; 54(2): 166 - 173. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. Bodi, J. Sanchis, J. Nunez, L. Mainar, M. P. Lopez-Lereu, J. V. Monmeneu, E. Rumiz, F. Chaustre, I. Trapero, O. Husser, et al. Prognostic Value of a Comprehensive Cardiac Magnetic Resonance Assessment Soon After a First ST-Segment Elevation Myocardial Infarction J. Am. Coll. Cardiol. Img., July 1, 2009; 2(7): 835 - 842. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Lautamaki, K. H. Schuleri, T. Sasano, M. S. Javadi, A. Youssef, J. Merrill, S. G. Nekolla, M. R. Abraham, A. C. Lardo, and F. M. Bengel Integration of Infarct Size, Tissue Perfusion, and Metabolism by Hybrid Cardiac Positron Emission Tomography/Computed Tomography: Evaluation in a Porcine Model of Myocardial Infarction Circ Cardiovasc Imaging, July 1, 2009; 2(4): 299 - 305. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Y. Kwong and M. A. Pfeffer Infarct haemorrhage detected by cardiac magnetic resonance imaging: are we seeing the latest culprit in adverse left ventricular remodelling? Eur. Heart J., June 2, 2009; 30(12): 1431 - 1433. [Full Text] [PDF]
|
|
|
|
|
|
V. Ariyarajah, J. W. Tam, and A. Khadem Inducible Malignant Ventricular Tachyarrhythmia in a Patient With Genotyped Hypertrophic Cardiomyopathy in Absence of Left Ventricular Hypertrophy or Enlargement Circulation, June 2, 2009; 119(21): e543 - e544. [Full Text] [PDF]
|
|
|
|
|
|
K. H. Schuleri, M. Centola, R. T. George, L. C. Amado, K. S. Evers, K. Kitagawa, A. L. Vavere, R. Evers, J. M. Hare, C. Cox, et al. Characterization of peri-infarct zone heterogeneity by contrast-enhanced multidetector computed tomography: a comparison with magnetic resonance imaging. J. Am. Coll. Cardiol., May 5, 2009; 53(18): 1699 - 1707. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. S. Flett, M. A. Westwood, L. C. Davies, A. Mathur, and J. C. Moon The Prognostic Implications of Cardiovascular Magnetic Resonance Circ Cardiovasc Imaging, May 1, 2009; 2(3): 243 - 250. [Full Text] [PDF]
|
|
|
|
|
|
S. D. Roes, C. J. W. Borleffs, R. J. van der Geest, J. J.M. Westenberg, N. A. Marsan, T. A.M. Kaandorp, J. H.C. Reiber, K. Zeppenfeld, H. J. Lamb, A. de Roos, et al. Infarct Tissue Heterogeneity Assessed With Contrast-Enhanced MRI Predicts Spontaneous Ventricular Arrhythmia in Patients With Ischemic Cardiomyopathy and Implantable Cardioverter-Defibrillator Circ Cardiovasc Imaging, May 1, 2009; 2(3): 183 - 190. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Vigmond, F. Vadakkumpadan, V. Gurev, H. Arevalo, M. Deo, G. Plank, and N. Trayanova Towards predictive modelling of the electrophysiology of the heart Exp Physiol, May 1, 2009; 94(5): 563 - 577. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Lockie, E. Nagel, S. Redwood, and S. Plein Use of Cardiovascular Magnetic Resonance Imaging in Acute Coronary Syndromes Circulation, March 31, 2009; 119(12): 1671 - 1681. [Full Text] [PDF]
|
|
|
|
|
|
D. Atar, P. Petzelbauer, J. Schwitter, K. Huber, B. Rensing, J. D. Kasprzak, C. Butter, L. Grip, P. R. Hansen, T. Suselbeck, et al. Effect of Intravenous FX06 as an Adjunct to Primary Percutaneous Coronary Intervention for Acute ST-Segment Elevation Myocardial Infarction: Results of the F.I.R.E. (Efficacy of FX06 in the Prevention of Myocardial Reperfusion Injury) Trial J. Am. Coll. Cardiol., February 24, 2009; 53(8): 720 - 729. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Nazarian, D. A. Bluemke, and H. R. Halperin Applications of Cardiac Magnetic Resonance in Electrophysiology Circ Arrhythm Electrophysiol, February 1, 2009; 2(1): 63 - 71. [Full Text] [PDF]
|
|
|
|
 |
|
 A. Holz, R. Lautamaki, T. Sasano, J. Merrill, S. G. Nekolla, A. C. Lardo, and F. M. Bengel Expanding the Versatility of Cardiac PET/CT: Feasibility of Delayed Contrast Enhancement CT for Infarct Detection in a Porcine Model J. Nucl. Med., February 1, 2009; 50(2): 259 - 265. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Y. Kwong Can cardiac magnetic resonance myocardial scar features affect treatment decisions for patients with coronary artery disease and heart failure? J. Am. Coll. Cardiol. Img., January 1, 2009; 2(1): 45 - 47. [Full Text] [PDF]
|
|
|
|
|
|
H. Engblom, E. Hedstrom, E. Heiberg, G. S. Wagner, O. Pahlm, and H. Arheden Rapid Initial Reduction of Hyperenhanced Myocardium After Reperfused First Myocardial Infarction Suggests Recovery of the Peri-Infarction Zone: One-Year Follow-Up by MRI Circ Cardiovasc Imaging, January 1, 2009; 2(1): 47 - 55. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. G. Strauss, R. H. Selvester, J. A.C. Lima, H. Arheden, J. M. Miller, G. Gerstenblith, E. Marban, R. G. Weiss, G. F. Tomaselli, G. S. Wagner, et al. ECG Quantification of Myocardial Scar in Cardiomyopathy Patients With or Without Conduction Defects: Correlation With Cardiac Magnetic Resonance and Arrhythmogenesis Circ Arrhythm Electrophysiol, December 1, 2008; 1(5): 327 - 336. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. J. Myerburg Implantable Cardioverter-Defibrillators after Myocardial Infarction N. Engl. J. Med., November 20, 2008; 359(21): 2245 - 2253. [Full Text] [PDF]
|
|
|
|
|
|
H. R. Halperin and S. Nazarian Damage Assessment After Ablation: Role of Cardiovascular Magnetic Resonance J. Am. Coll. Cardiol., October 7, 2008; 52(15): 1272 - 1273. [Full Text] [PDF]
|
|
|
|
 |
|
 M. S. Maron, E. Appelbaum, C. J. Harrigan, J. Buros, C. M. Gibson, C. Hanna, J. R. Lesser, J. E. Udelson, W. J. Manning, and B. J. Maron Clinical Profile and Significance of Delayed Enhancement in Hypertrophic Cardiomyopathy Circ Heart Fail, September 1, 2008; 1(3): 184 - 191. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Bogun, B. Desjardins, T. Crawford, E. Good, K. Jongnarangsin, H. Oral, A. Chugh, F. Pelosi, and F. Morady Post-Infarction Ventricular Arrhythmias Originating in Papillary Muscles J. Am. Coll. Cardiol., May 6, 2008; 51(18): 1794 - 1802. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. S. Adabag, B. J. Maron, E. Appelbaum, C. J. Harrigan, J. L. Buros, C. M. Gibson, J. R. Lesser, C. A. Hanna, J. E. Udelson, W. J. Manning, et al. Occurrence and Frequency of Arrhythmias in Hypertrophic Cardiomyopathy in Relation to Delayed Enhancement on Cardiovascular Magnetic Resonance J. Am. Coll. Cardiol., April 8, 2008; 51(14): 1369 - 1374. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Nazarian and J. A.C. Lima Cardiovascular Magnetic Resonance for Risk Stratification of Arrhythmia in Hypertrophic Cardiomyopathy J. Am. Coll. Cardiol., April 8, 2008; 51(14): 1375 - 1376. [Full Text] [PDF]
|
|
|
|
 |
|
 V. R. S. Fernandes, K. C. Wu, B. D. Rosen, A. Schmidt, A. C. Lardo, N. Osman, H. R. Halperin, G. Tomaselli, R. Berger, D. A. Bluemke, et al. Enhanced Infarct Border Zone Function and Altered Mechanical Activation Predict Inducibility of Monomorphic Ventricular Tachycardia in Patients with Ischemic Cardiomyopathy Radiology, December 1, 2007; 245(3): 712 - 719. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Jacquier, C. B. Higgins, A. J. Martin, L. Do, D. Saloner, and M. Saeed Injection of Adeno-associated Viral Vector Encoding Vascular Endothelial Growth Factor Gene in Infarcted Swine Myocardium: MR Measurements of Left Ventricular Function and Strain Radiology, October 1, 2007; 245(1): 196 - 205. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. J. Gibbons, P. A. Araoz, and E. E. Williamson The Year in Cardiac Imaging J. Am. Coll. Cardiol., September 4, 2007; 50(10): 988 - 1003. [Full Text] [PDF]
|
|
|
|
|
|
R. G Assomull, D. J Pennell, and S. K Prasad Cardiovascular magnetic resonance in the evaluation of heart failure Heart, August 1, 2007; 93(8): 985 - 992. [Full Text] [PDF]
|
|
|
|
|
|
J. Sanz, P. R. Moreno, and V. Fuster The Year in Atherothrombosis J. Am. Coll. Cardiol., April 24, 2007; 49(16): 1740 - 1749. [Full Text] [PDF]
|
|
|
|
|
|
A. Schmidt, C. F. Azevedo, A. Cheng, S. N. Gupta, D. A. Bluemke, T. K. Foo, G. Gerstenblith, R. G. Weiss, E. Marban, G. F. Tomaselli, et al. Infarct Tissue Heterogeneity by Magnetic Resonance Imaging Identifies Enhanced Cardiac Arrhythmia Susceptibility in Patients With Left Ventricular Dysfunction Circulation, April 17, 2007; 115(15): 2006 - 2014. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. J. Klocke, E. Wu, and D. C. Lee "Shades of Gray" in Cardiac Magnetic Resonance Images of Infarcted Myocardium: Can They Tell Us What We'd Like Them to? Circulation, July 4, 2006; 114(1): 8 - 10. [Full Text] [PDF]
|
|