What about CMR in patients with acute MI?

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Presentation transcript:

What about CMR in patients with acute MI?

Acute MI Infarct Transmurality CMR for viability in patients post-AMI showed similar findings as compared to studies of chronic MI Regional LV recovery is inversely related to transmural extent of DHE CMR can also evaluate MVO Gerber BL, et al. Circulation 2002

Microvascular Obstruction Acute anterior MI post PCI Acute MI Microvascular Obstruction Acute anterior MI post PCI MVO by MRI predicts significantly increased rate of CV complications after MI Wu KC, et al. Circulation 1998;97:765

MVO with DE-CMR

Perfusion vs DE-CMR for MVO

There is prognostic data for both DHE and MVO in the setting of AMI - which is a more powerful predictor of LV recovery?

Methods Studied patients presenting with first acute STEMI treated with primary PCI Underwent CMR at 3 days and 6 months MVO and DHE were analyzed on a global and regional level and compared to change in regional LVF Shapiro MD, et al. Am J Cardiol 2007;100:211-216

Relation of degree of transmurality of DHE and MVO at baseline Shapiro MD, et al. Am J Cardiol 2007;100:211-216

DHE vs MVO Change in Regional LVF Shapiro MD, et al. Am J Cardiol 2007;100:211-216

DHE vs MVO Change in Regional LVF Both degree of DHE and MVO predicted LV recovery at follow-up Unadjusted OR for any improvement in regional LVF with increasing DHE was 0.2 (p<0.001) whereas it was 0.4 (p<0.001) with increasing MVO However, when co-adjusted, the OR for LV recovery remained for degree of DHE (p<0.0001) but the relation with MVO was lost (p=0.64) Shapiro MD, et al. Am J Cardiol 2007;100:211-216

DHE vs MVO Change in Regional LVF Shapiro MD, et al. Am J Cardiol 2007;100:211-216

Regional LVF DHE and MVO Baseline Follow-up Shapiro MD, et al. Am J Cardiol 2007;100:211-216

Regional LVF DHE and MVO Both degree of DHE and MVO predicted LV recovery at follow-up All segments with >75% transmurality of DHE were akinetic at follow-up Although only 18% of segments with <50% transmurality had normal function at baseline, 62% recovered function at follow-up (only 1% demonstrated akinesia) Correlations with MVO were similar Shapiro MD, et al. Am J Cardiol 2007;100:211-216

DHE vs MVO Change in Regional LVF Moderate correlation between size MVO on FP and DHE imaging (R=0.78) Size of hypoenhanced area observed on FP larger than DHE 10.6 ± 6.3 g vs 4.2 ± 2.8 g There was a decrease but persistent area of hypoenhancement on DHE imaging on f/u scans 4.4 ± 1.8 g vs 0 g These 2 observations suggest that PD seen on FP represents more than just MVO and that area of hypoenhancement on DHE probably represents a more accurate measure of MVO Shapiro MD, et al. Am J Cardiol 2007;100:211-216