Abstract 2545: Clinical Value of Multidetector Computed Tomography for Early Evaluation of Myocardial Viability, Left Ventricular Remodeling and Prognosis After Acute Myocardial Infarction
Background: The clinical value of multidetector computed tomography (MDCT) in assessing myocardial reperfusion after acute myocardial infarction (AMI) is currently unclear. We aim to validate the ability of MDCT for assessing myocardial viability and predicting left ventricular (LV) remodeling after AMI.
Methods: In 52 consecutive patients with first AMI, 64-slice MDCT without iodine reinjection was performed immediately after selective coronary angiography. ECG-gated thallium-201 SPECT was performed using QGS programs within 5 days and 6 months after onset. Transmurality and extent of myocardial delayed enhancement (DE) were assessed, and results combined with angiographic, SPECT, clinical follow-up data at 6 months to evaluate functional and prognostic significance of DE findings.
Results: Among the 52 patients, 18 patients (Group A) showed transmural contrast DE, 20 patients (Group B) showed subendocardial contrast DE, and 14 patients (Group C) had no contrast DE. In the acute phase, peak CK-MB (483 ± 286, 223 ± 155, 129 ± 117 IU/ml, respectively, p = 0.0017) was significantly higher in Group A, while the incidence of myocardial blush grade 3 (22, 67, 75%, respectively, p = 0.0071) and LV ejection fraction (41 ± 8, 53 ± 13, 62 ± 11%, respectively, p < 0.001) were significantly lower in Group A. During the 6-month period, LVEDV increased significantly (110 ± 25 to 125 ± 21 mm3, p = 0.042) in Group A, and LV remodeling (p = 0.0064) and the number of re-hospitalization for heart failure (p = 0.0121) was more significantly observed in Group A.
Conclusions: Myocardial contrast DE patterns provide promising information regarding myocardial viability, LV remodeling and prognosis in AMI.