TY - JOUR
T1 - Epicardial Surface Area of Infarction
T2 - A Stable Surrogate of Microvascular Obstruction in Acute Myocardial Infarction
AU - Smulders, M.W.
AU - Van Assche, L.M.R.
AU - Bekkers, S.C.A.M.
AU - Nijveldt, R.
AU - Beijnink, C.W.H.
AU - Kim, H.W.
AU - Hayes, B.
AU - Parker, M.A.
AU - Kaolawanich, Y.
AU - Judd, R.M.
AU - Kim, R.J.
PY - 2021/2/1
Y1 - 2021/2/1
N2 - Background: Microvascular obstruction (MO) is a pathophysiologic complication of acute myocardial infarction that portends poor prognosis; however, it is transient and disappears with infarct healing. Much remains unknown regarding its pathophysiology and whether there are predictors of MO that could function as stable surrogates. We tested for clinical and cardiovascular magnetic resonance predictors of MO to gain insight into its pathophysiology and to find a stable surrogate. Methods: Three hundred two consecutive patients from 2 centers underwent cardiovascular magnetic resonance within 2 weeks of first acute myocardial infarction. Three measures of infarct morphology: infarct size, transmurality, and a new index-the epicardial surface area (EpiSA) of full-thickness infarction-were quantified on delayed-enhancement cardiovascular magnetic resonance. Results: Considering all clinical characteristics, only measures of infarct morphology were independent predictors of MO. EpiSA was the strongest predictor of MO and provided incremental predictive value beyond that of infarct size and transmurality (P<0.0001). In patients with 3-month follow-up cardiovascular magnetic resonance (n=81), EpiSA extent remained stable while MO disappeared, and EpiSA was a predictor of adverse ventricular remodeling. After 20 months of follow-up, 11 died and 1 had heart transplantation. Patients with an EpiSA larger than the median value (≥6%) had worse outcome than those with less than the median value (adverse events: 6.4% versus 1.9%, P=0.045). Conclusions: The EpiSA of infarction is a novel index of infarct morphology which accurately predicts MO during the first 2 weeks of MI, but unlike MO, does not disappear with infarct healing. This index has potential as a stable surrogate of the presence of acute MO and may be useful as a predictor of adverse remodeling and outcome which is less dependent on the time window of patient assessment.
AB - Background: Microvascular obstruction (MO) is a pathophysiologic complication of acute myocardial infarction that portends poor prognosis; however, it is transient and disappears with infarct healing. Much remains unknown regarding its pathophysiology and whether there are predictors of MO that could function as stable surrogates. We tested for clinical and cardiovascular magnetic resonance predictors of MO to gain insight into its pathophysiology and to find a stable surrogate. Methods: Three hundred two consecutive patients from 2 centers underwent cardiovascular magnetic resonance within 2 weeks of first acute myocardial infarction. Three measures of infarct morphology: infarct size, transmurality, and a new index-the epicardial surface area (EpiSA) of full-thickness infarction-were quantified on delayed-enhancement cardiovascular magnetic resonance. Results: Considering all clinical characteristics, only measures of infarct morphology were independent predictors of MO. EpiSA was the strongest predictor of MO and provided incremental predictive value beyond that of infarct size and transmurality (P<0.0001). In patients with 3-month follow-up cardiovascular magnetic resonance (n=81), EpiSA extent remained stable while MO disappeared, and EpiSA was a predictor of adverse ventricular remodeling. After 20 months of follow-up, 11 died and 1 had heart transplantation. Patients with an EpiSA larger than the median value (≥6%) had worse outcome than those with less than the median value (adverse events: 6.4% versus 1.9%, P=0.045). Conclusions: The EpiSA of infarction is a novel index of infarct morphology which accurately predicts MO during the first 2 weeks of MI, but unlike MO, does not disappear with infarct healing. This index has potential as a stable surrogate of the presence of acute MO and may be useful as a predictor of adverse remodeling and outcome which is less dependent on the time window of patient assessment.
KW - death
KW - delayed-enhancement CMR
KW - heart transplantation
KW - microvascular obstruction
KW - myocardial infarction
KW - prognosis
KW - ventricular remodeling
KW - PROGNOSIS
KW - CARDIOVASCULAR MAGNETIC-RESONANCE
KW - SIZE
KW - NO-REFLOW PHENOMENON
KW - ISCHEMIA
KW - DAMAGE
KW - UPDATE
KW - OCCLUSION
U2 - 10.1161/CIRCIMAGING.120.010918
DO - 10.1161/CIRCIMAGING.120.010918
M3 - Article
C2 - 33586449
SN - 1941-9651
VL - 14
JO - Circulation-Cardiovascular Imaging
JF - Circulation-Cardiovascular Imaging
IS - 2
M1 - 010918
ER -