Clinical Research
Prognosticators in Acute Infarction
Prognostic Value of Myocardial Infarct Size and Contractile Reserve Using Magnetic Resonance Imaging

https://doi.org/10.1016/j.jacc.2009.07.027Get rights and content
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Objectives

Our aim was to assess the predictive value of myocardial infarct size assessed with late gadolinium-enhanced (LGE) magnetic resonance imaging (MRI) in medically treated patients with chronic myocardial infarction relative to contractile reserve on low-dose dobutamine magnetic resonance (DSMR) for long-term event-free survival.

Background

Information on the relative merits of scar tissue and contractile reserve to predict long-term prognosis in patients with chronic myocardial infarction is lacking.

Methods

A total of 177 patients with known coronary artery disease and scar tissue on LGE MRI were enrolled. Left ventricular (LV) functional parameters at rest and during low-dose DSMR were assessed, and the wall motion score index was calculated.

Results

Eleven patients (6.2%) suffered an event during follow-up (average 20.3 months). Infarct size was a stronger predictor of events than LV ejection fraction and LV volumes at rest and during low-dose DSMR. Myocardial infarct size was used to separate patients at high risk (spatial extent ≥6 segments, n = 98) from those at low risk (spatial extent <6 segments, n = 79) for mortality. In the subgroup of patients at high risk, transmurality of infarct was not a predictor of events. However, the presence of contractile reserve (n = 63) was associated with a significantly higher number of events (12.7%) compared with no change in wall motion score index (6.7%; n = 15; p = 0.008).

Conclusions

Myocardial infarct size on LGE MRI is a stronger predictor of clinical outcome than contractile reserve in medically treated patients with myocardial infarction. In patients with large myocardial scar, the presence of contractile reserve is more important for the prediction of events than scar tissue.

Key Words

cardiac magnetic resonance
prognosis
delayed enhancement
contractile reserve

Abbreviations and Acronyms

CI
confidence interval
DSMR
dobutamine magnetic resonance
LGE
late gadolinium enhancement
LV
left ventricle/ventricular
LVEDV
left ventricular end-diastolic volume
LVEF
left ventricular ejection fraction
LVESV
left ventricular end-systolic volume
MRI
magnetic resonance imaging
WMSI
wall motion score index

Cited by (0)

Dr. Bax has received research grants from Edwards Lifesciences, Biotronik, GE Healthcare, BMS Medical Imaging, St. Jude, and Medtronic. Dr. Nagel has received grants from Philips Healthcare and Bayer-Schering. The first 2 authors contributed equally to this work. W. Gregory Hundley, MD, served as Guest Editor for this article.