scholarly journals USE OF BIOMARKERS AND CARDIAC MAGNETIC RESONANCE FOR DETECTION OF MYOCARDIAL INFARCTION RELATED TO CORONARY REVASCULARIZATION PROCEDURES

2014 ◽  
Vol 63 (12) ◽  
pp. A1148
Author(s):  
Rodrigo Vieira de Melo ◽  
Fernando Teiichi Oikawa ◽  
Leandro Costa ◽  
Paulo Rezende ◽  
Celia Strunz ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Coronary Revascularization ◽  
Revascularization Procedures

Abstract 12590: Usefullness of Early Release Peak of Cardiac Biomarkers for Detection of Myocardial Infarction Related to Coronary Revascularization Procedures. A Cardiac Magnetic Resonance Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Rodrigo M Vieira de Melo ◽  
Fernando T Oikawa ◽  
Leandro M Costa ◽  
Paulo C Rezende ◽  
Thiago L Scudeler ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Myocardial Injury ◽  
Coronary Revascularization ◽  
Cardiac Biomarkers ◽  
Early Release ◽  
Before And After ◽  
Peak Release ◽  
Revascularization Procedures

Background: The elevation of troponin (TnI) and creatine kinase-MB (CKMB) after coronary revascularization procedures is frequent, but may not be reliable at identifying a definitive procedure-related myocardial injury. Cardiac magnetic resonance (CMR) is the gold standard in the identification of small areas of myocardial necrosis by late gadolinium enhancement (LGE). The presence of a biomarker early release peak might indicate a nonlethal transient cellular myocardial damage and help to discriminate the patients without procedure-related myocardial lesion. Thus, our objective was to evaluate the amount and pattern of release of biomarkers after coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) compared with the area of new LGE on CMR. Methods: Patients with indication for coronary revascularization were included. Measurements of high-sensitivity TnI and CK-MB were obtained before and after the procedures, every 6 hours until 48 hours after PCI, and up to 72 hours after CABG. We evaluated the area under the curve (AUC) and peak release of biomarkers and stratified before and 24 hours after the procedure. CMR was performed before and after procedures with quantification of necrosis by LGE. Results: From 150 patients who completed the study, 60 (40%) underwent CABG with cardiopulmonary bypass (CPB), 44 (29.3%) without CPB, and 46 (30.7%) underwent PCI. 130 (86.7%) exhibited release of cardiac biomarkers consistent with myocardial injury, however only 32 (21.3%) had new LGE on CMR. The AUC and peak release of TnI showed a moderate correlation with the mass of new myocardial LGE on CMR (AUC: r = 0.46, P < 0.0001; TnI peak: r = 0.45, P < 0.0001), as well as the AUC and peak release of CKMB (AUC: r = 0.33, P < 0.0001; CK-MB peak: r = 0.35, P <0.0001). Patients without new LGE on CMR had more frequently an early peak release of cardiac biomarkers when compared with those with new LGE: 63 (88.7%) vs. 8 (11.3%), P = 0.004. Conclusion: The elevation of cardiac biomarkers after coronary revascularization procedures had a low diagnostic power for the detection of new myocardial areas of infarction identified by LGE on CMR. The early release of biomarkers may be useful to rule out the diagnosis of peri-procedural myocardial infarction.

scholarly journals Cardiac magnetic resonance derived global longitudinal strain outperfoms established functional parameters in prognostication after ST-elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Holzknecht ◽  
M Reindl ◽  
C Tiller ◽  
I Lechner ◽  
T Hornung ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Prognostic Value ◽  
Longitudinal Strain ◽  
Independent Predictor ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Lv Function ◽  
St Elevation

Abstract Background Left ventricular ejection fraction (LVEF) is the parameter of choice for left ventricular (LV) function assessment and risk stratification of patients with ST-elevation myocardial infarction (STEMI); however, its prognostic value is limited. Other measures of LV function such as global longitudinal strain (GLS) and mitral annular plane systolic excursion (MAPSE) might provide additional prognostic information post-STEMI. However, comprehensive investigations comparing these parameters in terms of prediction of hard clinical events following STEMI are lacking so far. Purpose We aimed to investigate the comparative prognostic value of LVEF, MAPSE and GLS by cardiac magnetic resonance (CMR) imaging in the acute stage post-STEMI for the occurrence of major adverse cardiac events (MACE). Methods This observational study included 407 consecutive acute STEMI patients treated with primary percutaneous coronary intervention (PCI). Comprehensive CMR investigations were performed 3 [interquartile range (IQR): 2–4] days after PCI to determine LVEF, GLS and MAPSE as well as myocardial infarct characteristics. Primary endpoint was the occurrence of MACE defined as composite of death, re-infarction and congestive heart failure. Results During a follow-up of 21 [IQR: 12–50] months, 40 (10%) patients experienced MACE. LVEF (p=0.005), MAPSE (p=0.001) and GLS (p&lt;0.001) were significantly related to MACE. GLS showed the highest prognostic value with an area under the curve (AUC) of 0.71 (95% CI 0.63–0.79; p&lt;0.001) compared to MAPSE (AUC: 0.67, 95% CI 0.58–0.75; p=0.001) and LVEF (AUC: 0.64, 95% CI 0.54–0.73; p=0.005). After multivariable analysis, GLS emerged as sole independent predictor of MACE (HR: 1.22, 95% CI 1.11–1.35; p&lt;0.001). Of note, GLS remained associated with MACE (p&lt;0.001) even after adjustment for infarct size and microvascular obstruction. Conclusion CMR-derived GLS emerged as strong and independent predictor of MACE after acute STEMI with additive prognostic validity to LVEF and parameters of myocardial damage. Funding Acknowledgement Type of funding source: None

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