European Heart Journal Advance Access originally published online on January 23, 2008
European Heart Journal 2008 29(4):490-498; doi:10.1093/eurheartj/ehm630
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Early validation study of 64-slice multidetector computed tomography for the assessment of myocardial viability and the prediction of left ventricular remodelling after acute myocardial infarction
1 Department of Cardiology, Yokosuka Kyosai Hospital, 1-16 Yonegahamadori, Yokosuka, Japan
2 Department of Nephrology and Cardiology, International Medical Center of Japan, Tokyo
3 Department of Cardiovascular Medicine, Tokyo Medical and Dental Postgraduate School of Medicine, Tokyo
4 Department of Cardiology, University of Tsukuba Graduate School of Comprehensive Human Science, Tsukuba
Received 26 February 2007; revised 26 November 2007; accepted 20 December 2007; online publish-ahead-of-print 23 January 2008.
* Corresponding author. Tel: +81 46 822 2710, Fax: +81 46 829 0552, Email: asato{at}yf6.so-net.ne.jp
Aims: We aim to validate the ability of multidetector computed tomography (MDCT) for assessing myocardial viability and predicting left ventricular (LV) remodelling after acute myocardial infarction (AMI).
Methods and results: In 52 consecutive patients with first AMI, 64-slice MDCT without iodine re-injection was performed immediately following coronary stenting. Electrocardiogram-gated thallium-201 single-photon emission tomography was performed using QGS programs within 5 days and 6 months after onset. Among the 52 patients, 18 patients (Group A) showed transmural contrast-delayed enhancement on MDCT images, 20 patients (Group B) showed subendocardial contrast-delayed enhancement, and 14 patients (Group C) had no contrast-delayed enhancement. In the acute phase, peak creatine kinase-MB [497 (189–744), 182 (90–358), 85 (40–204) IU/mL, respectively, P = 0.0004] was significantly higher in Group A, while the incidence of myocardial blush grade 3 (22, 67, 75%, respectively, P = 0.001) and LV ejection fraction (41 ± 7, 53 ± 12, 62 ± 11%, respectively, P < 0.0001) were significantly lower in Group A. During the 6-month period, LV remodelling (P = 0.001) and the number of rehospitalization for heart failure (P = 0.0017) were more significantly observed in Group A.
Conclusion: Myocardial contrast-delayed enhancement patterns provide promising information regarding myocardial viability, LV remodelling, and prognosis in AMI.
Key Words: MDCT • Perfusion • Myocardial infarction • Remodelling