Abstract 2350: Clinical Feasibility and Applicability of Measuring Pre-ejection Velocity in the Prediction of Myocardial Viability with Delayed-enhanced magnetic Resonance Imaging as a Reference in Patients with Myocardial Infarction
Background- +Pre-ejection velocity(PEV) was reported to predict recovery of regional myocardial systolic function after revascularization(PCI) in patients with myocardial infarction(MI). We sought to evaluate the clinical feasibility and accuracy of +PEV in the prediction of myocardial viability with delayed-enhanced magnetic resonance imaging(deMRI) as a reference tool.
Methods & Results- We enrolled 29 patients with MI, who underwent standard echocardiography, deMRI, and successful PCI. With tissue velocity imaging(TVI), 3 apical views were recorded at rest to estimate PEV <1 week after PCI. +PEV was coded as viable, while −PEV, nonviable. To evaluate infarct thickness of myocardial walls, deMRI was also performed <1 week after PCI. Myocardium was regarded as viable when infarct thickness of a given wall was <50%. Apical segments were not evaluated due to difficulty in aligning Doppler beam with vector of regional motion. A satisfactory PEV was obtained in 286 of 296 segments(96.7%). There were 55 nonviable segments(19%), among which 33 segments showed +PEV(60%). Of note, −PEV was noted only in 2 of 6 myocardial segments with scar(33.3%). The overall sensitivity, specificity, and accuracy for predicting myocardial viability were 80.3%, 40%, and 70.9%, respectively. Inter- and intra-observer variabilities were 9.3% and 6.4%, respectively
Conclusions- Detection of PEV with TVI in apical views is feasible and reproducible. Yet, despite previous enthusiasm for PEV, it cannot be used to predict myocardial viability in routine clinical practice due to its low specificity. However, myocardium with +PEV and without scar can be considered viable with an acceptable accuracy.