scholarly journals 609 Prognostic role of renal function in patients with previous myocardial infarction. A study with cardiac magnetic resonance

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Davide Restelli ◽  
Roberto Licordari ◽  
Paolo Piaggi ◽  
Scipione Carerj ◽  
Domenico Santoro ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Renal Function ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Renal Impairment ◽  
Ejection Fraction ◽  
Independent Predictor ◽  
Left Ventricular ◽  
Cardiac Events ◽  
Mild Renal Impairment

Abstract Aims There is not strong evidence in literature about the impact of renal function on the prognosis of patients with ischaemic cardiomyopathy. Thus, the aim of the study was to investigate mild renal impairment [estimated glomerular filtration rate (eGFR): 60–89 ml/min] as an independent prognostic factor in patients with history of myocardial infarction (MI). Methods and results We studied 339 consecutive patients (65 ± 13 years old, female 13%) from 2001 and 2012 with previous MI. Patients with eGFR <60 ml/min were excluded. We performed cardiac magnetic resonance (CMR) in all patients to quantify left ventricular ejection fraction (LVEF), volumes, and wall motion score index (WMSI), and to measure the infarction extent by late gadolinium enhancement (LGE). Renal function was estimated by creatinine value with Cockcroft–Gault formula and patients were divided according to normal (≥90 ml/min) and reduced (60–89 ml/min) eGFR. Patients with normal eGFR were 106 (31%, 56.9 ± 10.5 years old), 233 (69%, 66.1 ± 9.9 years old) had renal impairment. During follow-up (median 3.5 years), cardiac events (cardiac death or appropriate intra-cardiac defibrillator shock) occurred in 28/233 (12%) of patients with eGFR <90 ml/min and in 4/106 (4%) of patients with eGFR ≥90 ml/min (P < 0.05). Furthermore, survival curve showed a significantly worst prognosis in patients with renal impairment (P < 0.03). In the group of patients with ejection fraction (EF) < 35% (121 patients), cardiac events were observed only in patients with eGFR <90 ml/min (23/99, 23%, P < 0.05). At multivariate stepwise analysis, age >65 years old, eGFR <90 ml/min and WMSI >1.7 turned out to be independent predictor of cardiac events (P < 0.05). Conclusions In patients with previous MI, a mild renal impairment (eGFR between 60 and 89 ml/min) was an independent predictor of prognosis, especially if combined with left ventricular disfunction.

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<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<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<0.001). Of note, GLS remained associated with MACE (p<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

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

2021 ◽  
Vol 22 (Supplement_1) ◽  
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 ◽  
Acute Stemi ◽  
St Elevation

Abstract Funding Acknowledgements Type of funding sources: None. Background Although left ventricular ejection fraction (LVEF) is recommended for left ventricular (LV) systolic function assessment and risk stratification of patients with ST-elevation myocardial infarction (STEMI), 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 acute STEMI patients. 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. Patients with MACE showed significantly lower LVEF (49% vs. 53%, p = 0.005) and MAPSE (7.9 mm vs. 9.1 mm, p = 0.001), as well as higher GLS values (-10.2% vs. -12.3 %, p < 0.001). GLS showed the highest prognostic value with an area under the curve (AUC) of 0.71 (95% CI 0.63-0.79; p < 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 independent predictor of MACE (HR: 1.22, 95% CI 1.11-1.35; p < 0.001). Of note, GLS remained associated with MACE (p < 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.

scholarly journals Prognosis of early pre-discharge and late left ventricular dilatation by cardiac magnetic resonance imaging after acute myocardial infarction

2021 ◽  
Author(s):  
Martin R. Sinn ◽  
Gunnar K. Lund ◽  
Kai Muellerleile ◽  
Eric Freiwald ◽  
Maythem Saeed ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Myocardial Infarction ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Ejection Fraction ◽  
Cardiac Magnetic Resonance Imaging ◽  
Left Ventricular ◽  
Resonance Imaging

AbstractTo study the long-term prognosis of early pre-discharge and late left ventricular (LV) dilatation in patients with first ST-elevation myocardial infarction (STEMI) treated by percutaneous coronary intervention (PCI) and contemporary medical therapy. Long-term follow-up > 15 years was available in 53 consecutive patients (55 ± 13 years) with first STEMI. Late gadolinium enhanced (LGE) cardiac magnetic resonance imaging (CMR) was obtained at baseline 5 ± 3 days and follow-up 8 ± 3 months after STEMI to measure LV function, volumes and infarct size. Early pre-discharge dilatation was defined as increased left ventricular end-diastolic volume index (LVEDVi) at baseline CMR with > 97 ml/m2 for males and > 90 ml/m2 for females. Late dilatation was defined as initially normal LVEDVi, which increased ≥ 20% at follow-up. Early dilatation was present in 7 patients (13%), whereas late dilatation occurred in 11 patients (21%). Patients with early LV dilatation had highest mortality (57%), whereas patients with late dilatation had similar mortality (27%) compared to patients without dilatation (26%). Multivariate Cox analysis showed that age (P < 0.001), ejection fraction at baseline (P < 0.01) and early dilatation (P < 0.01) were independent predictors of death. Early dilatation qualified as an exclusive independent predictor of long-term mortality after adjustment for age and ejection fraction (P < 0.05, hazard ratio: 2.2, 95% confidence interval: 1.2 to 7.9). Early pre-discharge LV dilatation by CMR enabled strong long-term risk stratification after STEMI. The high mortality of early LV dilatation underscores the clinical importance of this post-infarction complication, which occurred despite PCI and contemporary medical therapy.

Abstract 9634: As Compared With Cardiac Magnetic Resonance Imaging, Transthoracic Echocardiography Has an Excellent Accuracy in Diagnosing a Left Ventricular Thrombus After an Anterior Myocardial Infarction Complicated With Left Ventricular Dysfunction: Results of a Prospective Multicentric Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Philippe Meurin ◽  
Virginie Brandao Carreira ◽  
Raphaelle D Dumaine ◽  
Alain Shqueir ◽  
Olivier Milleron ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Myocardial Infarction ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Cardiac Magnetic Resonance Imaging ◽  
Antiplatelet Therapy ◽  
Transthoracic Echocardiography ◽  
Dual Antiplatelet Therapy ◽  
Left Ventricular ◽  
Resonance Imaging

Introduction: The generalization of reperfusion techniques to treat acute myocardial infarction (MI) has allowed for markedly reduced incidence in left ventricular (LV) thrombi because of the reduced myocardial damage. LV thrombi are estimated to complicate 5% to 10% of unselected anterior-wall MI (Ant-MI). However, the incidence and evolution of LV thrombi in high-risk patients with Ant-MI complicated by LV systolic dysfunction is not well known. Cardiac magnetic resonance imaging with contrast delayed enhancement (CMR-DE) is the gold standard in assessing LV thrombus, but comparisons of transthoracic echocardiography (TTE) and CMR-DE are scarce. Hypothesis: We assessed whether LV thrombi are still frequent after major Ant-MI, despite systematic dual antiplatelet therapy, and whether focused TTE has a good accuracy for detection as compared with CMR-DE. Methods: From 2011 to 2013, from 7 centers, we prospectively included patients with LV ejection fraction (LVEF) < 45% at a first TTE performed < 7 days after Ant-MI. A second evaluation including TTE and CMR-DE (analyzed by blinded examiners) was performed at 30 days. A third TTE and assessment of clinical status and adverse events were performed between months 6 and 12. Results: We included 100 consecutive patients (71% males; mean age 59.1 ± 12.1 years; LVEF 33.5 ± 6.0%) at a mean of 4.8 ± 1.9 days after Ant-MI; 88% had undergone primary coronary angioplasty. In total, 26 patients had LV thrombi detected at a mean of 23.2 ± 34.8 days after MI (6 during the first week after the MI, 16 from days 8 to 30, 4 after day 30). As compared with CMR-DE, TTE sensitivity and specificity were 94.7% and 98.5%, respectively. For 24 patients (92.3%), the LV thrombi disappeared with triple antithrombotic therapy including dual antiplatelet therapy and a vitamin K antagonist. One patient died from a recurrent subdural haematoma and another had a peripheral embolism. Conclusions: In this prospective multicenter study, LV thrombus occurred in 26% of patients after Ant-MI complicated by LV dysfunction. Focused TTE has a high accuracy for detection. CMR-DE should be performed only when the apex is not clearly seen.

Sign in / Sign up

Export Citation Format

Share Document