European Heart Journal Advance Access originally published online on February 15, 2005
European Heart Journal 2005 26(6):549-557; doi:10.1093/eurheartj/ehi147
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Sequelae of acute myocardial infarction regarding cardiac structure and function and their prognostic significance as assessed by magnetic resonance imaging
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,Department of Internal Medicine II - Cardiology, University of Ulm, Robert-Koch-Strasse 8, D-89081 Ulm, Germany
Received 10 July 2004; revised 17 December 2004; accepted 23 December 2004; online publish-ahead-of-print 15 February 2005.
* Corresponding author. Tel: +49 731 500 24441; fax: +49 731 500 24442. E-mail address: vinzenz.hombach{at}medizin.uni-ulm.de
See page 532 for the editorial comment on this article (doi:10.1093/eurheartj/ehi156)
Aims Because of its high spatial resolution and tissue contrast, magnetic resonance imaging (MRI) was used to assess cardiac structure and function in a large population of patients with acute myocardial infarction (AMI).
Methods and results One hundred and ten patients were studied by MRI 6.1±2.2 days after AMI. Infarct size (IS), persistent microvascular obstruction (PMO), left and right ventricular (LV/RV) volumes, and functions were measured. The same MRI measurements were repeated in 89 patients after a mean follow-up period of 225±92 days. IS was 11.9±7.3% of total LV muscle mass. PMO was detected in 51/110 (46.4%) patients and comprised 15.6±8.5% of IS and 2.8±2.3% of LV muscle mass. Papillary muscle infarct was seen in 26%, RV infarction in 16%, pericarditis in 40%, and pericardial effusion in 66% of the patients. During follow-up, there were 16 major adverse cardiac events (MACE) including seven deaths. IS, PMO, and amount of transmural infarction were predictive for LV adverse remodelling defined as >20% increase in LV end-diastolic volume. Multivariable analysis revealed LV end-diastolic volume, LV ejection fraction, and PMO as significant predictors for the occurrence of MACE.
Conclusion MRI is a highly sensitive and reliable tool to detect morphologic and functional sequelae of AMI providing baseline MRI parameters with relevant predictive power for LV adverse remodelling and occurrence of MACE.
Key Words: Magnetic resonance imaging • Infarct size • Microvascular obstruction • Myocardial viability • Right ventricular infarction • Coronary heart disease
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