Abstract 13921: Head-to-head Comparison of Real-Time Myocardial Perfusion Echocardiography vs Cardiac Magnetic Resonance in Patients with Revascularized ST-Elevation Myocardial Infarction: Prognostic Implications
Objectives: To compare real-time myocardial perfusion echocardiography (RTMPE) with myocardial-delayed enhancement imaging on cardiac magnetic resonance (CMR) for prediction of cardiac events (CE) in revascularized STEMI patients (pts).
Methods: Consecutive acute STEMI pts with acute reperfusion by PCI and/or thrombolysis were studied. RTMPE (Definity) and CMR were performed within 1.04± .8 days & 1.7±1.2 days from PCI, respectively. Visual assessments of perfusion by RTMPE and transmural necrosis extent by CMR in 17-segments were graded independently as:0=normal/no scar;1=hypoperfused/non transmural scar;2=absent perfusion/transmural scar. Perfusion score indices PSI RTMPE & PSI CMR were calculated [sum of segmental perfusion scores / segments]. CMR infarct mass (g) and RTMPE myocardial blood flow [MBF dB/sec] were quantified. Pts were followed for CE [death, nonfatal MI, revascularization, angina, and heart failure]. Cox regression analysis was done.
Results: All 27 pts [age 62 ±14; follow-up 3.5±2.6 yrs] had TIMI grade 3 flow of revascularized infarct vessel. CE occurred in 17 (63%) (death=5,STEMI=1, angina=4,CABG=1,PCI=2,HF=4). CE pts had higher PSIRTMPE , PSICMR , infarct mass, and lower MBF Figures A,B. PSIRTMPE cutoff .3 had AUC .856 [82% sensitivity,70% specificity], while PSICMR cutoff .2 had AUC .765 [76 % sensitivity, 60% specificity]. Pts with PSICMR ≥ .2; infarct mass ≥ 14; PSIRTMPE≥ .3 and MBF ≤.557 had increased CE [log-rank X2 1.6, P=.21; 5.7, P=.02; 4.3, P=.04,and 5.1, P=.02 respectively]. Infarct mass and MBF were independent predictors of CE after adjusting for risk factors [hazard ratios: 20.9 (95% CI 1.8-256) P=.02 and 8.1 (95% CI 1.5-78) P =.01, respectively].No pts had side-effects reported.
Conclusions: RTMPE performed comparably to CMR in excellent prediction of subsequent cardiac events in revascularized STEMI pts. These findings support a prognostic role for this novel, readily available, noninvasive, bedside imaging method.
Author Disclosures: S.S. Abdelmoneim: None. N.S. Anavekar: None. T.A. Foley: None. M. Martinez: None. L.F. Nhola: None. R. Huang: None. J.K. Oh: None. S.L. Mulvagh: None.
- © 2014 by American Heart Association, Inc.