Abstract 14005: Myocardium at Risk in Revascularized Non-ST-Elevation Myocardial Infarction Assessed by Cardiac Magnetic Resonance Imaging and Validated by the Invasive Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease Score
Background: In the setting of acute myocardial ischemia, the hypoperfused portion of the myocardium is in danger of becoming irreversibly injured. This portion of myocardium is often referred to as area at risk (AAR) and is correlated to adverse events and outcome.
Hypothesis: Aim of the trial at hand was to assess the AAR in patients with acute non-ST-elevation myocardial infarction (NSTEMI) by cardiac magnetic resonance imaging (CMR). Results were validated by the well-established Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease Score (APPROACH-score) that was assessed by invasive coronary x-ray angiography.
Methods: Sixty-four patients presenting with acute NSTEMI who underwent coronary x-ray angiography including subsequent percutaneous coronary intervention within 72 hours of symptom onset were enrolled. Two blinded readers performed offline angiographic AAR assessment using the modified APPROACH-score. For measurement of AAR by CMR, a 1.5 T whole-body scanner with a 32-channel phased-array surface coil was used. Besides functional and volumetric analyses, a 3D T2-weighted black-blood fat-saturated spin-echo sequence was used for visualization of myocardial edema. Area at risk was calculated as edema volume in relation to left ventricular mass. Using this technique, AAR was quantified semi-automatically by two blinded readers in consensus.
Results: Mean age of study cohort was 62.9 years. Forty-four subjects were male (73.3%), mean symptom-to-balloon time was 1212 ± 976 min. The resulting mean AAR determined by the modified APPROACH-score was 28.6 ± 10.0%. The mean CMR derived AAR was 27.9 ± 13.7%. CMR assessment tended to slightly underestimate the AAR in comparison to angiographic scoring (difference -0.21 ± 8.1 %, p=NS). A good correlation between the AAR assessed by CMR and by angiography (r=0.84, p<0.0001) was observed.
Conclusion: T2-weigthed CMR is able to quantify the AAR with very good correlation to the angiographic APPROACH-score in NSTEMI patients. Therefore, CMR might serve as an excellent surrogate in clinical reperfusion trials.
Author Disclosures: D. Buckert: None. N. Dyckmanns: None. V. Rasche: None. W. Rottbauer: None. P. Bernhardt: None.
- © 2015 by American Heart Association, Inc.