Title

Non-transmural myocardial infarction associated with regional contractile function is an independent predictor of positive outcome: an integrated approach to myocardial viability

Authors

Gianluca Di Bella, Clinical and Experimental Department of Medicine, University of Messina, via Consolare Valeria 1, 98100, Messina, Italy.
Giovanni Donato Aquaro, Fondazione Toscana G. Monasterio, via Giuseppe Moruzzi 1, 56124, Pisa, Italy.
Jan Bogaert, Department of Radiology, KU Leuven - UZ Leuven, Gasthuisberg Campus. Herestraat 49, 3000, Leuven, Belgium.
Paolo Piaggi, Department of Information Engineering, University of Pisa, via G. Caruso 16, 56122, Pisa, Italy.
Antonio Micari, Clinical and Experimental Department of Medicine, University of Messina, via Consolare Valeria 1, 98100, Messina, Italy.
Fausto Pizzino, Department of Cardiology, "Santa Maria Dei Battuti" Hospital, Conegliano - ULSS2 Marca Trevigiana, Via Brigata Bisagno 2, 31015, Conegliano, Treviso, Italy.
Giovanni Camastra, Cardiac Department, Vannini Hospital Rome, via Acqua Bullicante 4, 00177, Roma, Italy.
Scipione Carerj, Clinical and Experimental Department of Medicine, University of Messina, via Consolare Valeria 1, 98100, Messina, Italy.
Mariapaola Campisi, Clinical and Experimental Department of Medicine, University of Messina, via Consolare Valeria 1, 98100, Messina, Italy.
Antonio Bracco, Clinical and Experimental Department of Medicine, University of Messina, via Consolare Valeria 1, 98100, Messina, Italy.
Maria Ludovica Carerj, Clinical and Experimental Department of Medicine, University of Messina, via Consolare Valeria 1, 98100, Messina, Italy.
Michele Emdin, Fondazione Toscana G. Monasterio, via Giuseppe Moruzzi 1, 56124, Pisa, Italy.
Bijoy K. Khandheria, Advocate Aurora HealthFollow
Alessandro Pingitore, C.N.R. Clinical Physiology Institute, via Giuseppe Moruzzi 1, 56124, Pisa, Italy.

Affiliations

Aurora Cardiovascular and Thoracic Services, Advocate Aurora Health, Aurora Sinai/Aurora St. Luke's Medical Centers

Abstract

Background: Cardiovascular magnetic resonance permits assessment of irreversible myocardial fibrosis and contractile function in patients with previous myocardial infarction. We aimed to assess the prognostic value of myocardial fibrotic tissue with preserved/restored contractile activity.

Methods: In 730 consecutive myocardial infarction patients (64 ± 11 years), we quantified left ventricular (LV) end-diastolic (EDV) and end-systolic (ESV) volumes, ejection fraction (EF), regional wall motion (WM) (1 normal, 2 hypokinetic, 3 akinetic, 4 dyskinetic), and WM score index (WMSI), and measured the transmural (1-50 and 51-100) and global extent of the infarct scar by late gadolinium enhancement (LGE). Contractile fibrotic (CT-F) segments were identified as those showing WM-1 and WM-2 with LGE ≤ or ≥ 50%.

Results: During follow-up (median 2.5, range 1-4.7 years), cardiac events (cardiac death or appropriate implantable defibrillator shocks) occurred in 123 patients (17%). At univariate analysis, age, LVEDV, LVESV, LVEF, WMSI, extent of LGE, segments with transmural extent > 50%, and CT-F segments were associated with cardiac events. At multivariate analysis, age > 65 years, LVEF < 30%, WMSI > 1.7, and dilated LVEDV independently predicted cardiac events, while CT-F tissue was the only independent predictor of better outcome. After adjustment for LVEF < 30% and LVEDV dilatation, the presence of CT-F tissue was associated with good prognosis.

Conclusions: In addition to CMR imaging parameters associated with adverse outcome (severe LV dysfunction, poor WM, and dilated EDV), the presence of fibrotic myocardium showing contractile activity in patients with previous myocardial infarction yields a beneficial effect on patient survival.

Document Type

Article

PubMed ID

34719402

Link to Full Text

 

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