Abstract 18572: Left Ventricle Reverse Remodeling After Acute Myocardial Infarction Predicted by MVO (CE-CMR). A Meta-Analysis of Prospective Trials
Background: Microvascular obstruction (MVO) is a predictor for reverse remodeling as evidenced by an increase in left ventricle end diastolic volume index (LVEDVi) and left end systolic volume index (LVESVi) in patients following acute myocardial infarction (AMI). Contrast Enhanced CMR (CE-CMR) is the leading diagnostic modality to access the presence and extent of MVO.
Objective: To determine the predictive value of MVO detected by CE-CMR as a predictor for Reverse remodeling in patients with AMI
Methods: A systemic review of Medline, Cochrane, and Embase for all the clinical trials using CMR to detect MVO and assessing its association reverse remodeling was performed. Given the high heterogeneity (i.e. I2 > 25), we used a random effect model.
Results: A total of 6 studies with 423 patients (male: 83%, mean age 61 years (SD=+/-4) and average EF of 40% (SD+/-3) fulfilled the inclusion criteria. The overall incidence for MVO was 57% (230) (SD= +/- 7). Head to head comparison of patients with and without evidence of MVO on initial CMR with in 1 week for AMI showed a higher incidence of reverse remodeling on the follow up CMR at a mean time of 6 months (SD+/-1). Patients with evidence of MVO had significantly higher volumes. The mean difference in LVEDVi and LVESVi between the initial and follow up MRI was 8.11 (95% CI 4.49-11.73) and 9.10 (95% CI 6.21-12.18) respectively.
Conclusion: MVO detected by CE-CMR is a strong predictor for LV reverse remodeling in patients suffering from acute myocardial infarction.
- © 2013 by American Heart Association, Inc.