Comparison of myocardial infarct size assessed with contrast-enhanced magnetic resonance imaging and left ventricular function and volumes to predict mortality in patients with healed myocardial infarction
Comparison of myocardial infarct size assessed with contrast-enhanced magnetic resonance imaging and left ventricular function and volumes to predict mortality in patients with healed myocardial infarction
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DOI：
10.1016/j.amjcard.2007.04.029
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发表时间：
2007-09-15
影响因子：
2.8
通讯作者：
Bax, Jeroen J.
中科院分区：
文献类型：
--
作者：
Roes, Stijntje D.;Kelle, Sebastian;Bax, Jeroen J.
目前，左心室（LV）射血分数（EF）和/或LV容积是冠状动脉疾病（CAD）和严重LV功能障碍患者死亡率的既定预测指标。通过对比增强的磁共振成像（MRI），现在可以精确描绘梗死面积。LVEFILV体积和梗死面积预测长期预后的相对优势尚不清楚。本研究的目的是确定对比增强MRI评估的梗死面积相对于LVEF和LV体积对心肌梗死愈合患者长期生存的预测价值。对231例心肌梗死患者行MRI电影和增强扫描。测量LVEF和LV容积，并通过对比增强MRI得出梗死面积。19名患者（8.2%）在中位随访1.7年期间死亡（四分位数范围1.1 - 2.9）。考克斯比例风险分析显示梗死面积定义为空间范围（风险比[HR] 1.3，95%置信区间[CI] 1.1 - 1.6，卡方检验6.7，p = 0.010），透壁性（HR 1.5，95% CI 1.1 - 1.9，卡方8.9，p = 0.003）或总瘢痕评分（HR 6.2，95% CI 1.7 - 23，卡方7.4，p = 0.006）是比LVEF和I-V容积更强的全因死亡率预测因子。总之，在预测心肌梗死治愈患者的长期死亡率方面，对比增强MRI上的梗死面积可能优于LVEF和LV体积的上级指标。(c)2007爱思唯尔公司All rights reserved.
Currently, left ventricular (LV) ejection fraction (EF) and/or LV volumes are the established predictors of mortality in patients with coronary artery disease (CAD) and severe LV dysfunction. With contrast-enhanced magnetic resonance imaging (MRI), precise delineation of infarct size is now possible. The relative merits of LVEFILV volumes and infarct size to predict long-term outcome are unknown. The purpose of this study was to determine the predictive value of infarct size assessed with contrast-enhanced MRI relative to LVEF and LV volumes for long-term survival in patients with healed myocardial infarction. Cine MRI and contrast-enhanced MRI were performed in 231 patients with healed myocardial infarction. LVEF and LV volumes were measured and infarct size was derived from contrast-enhanced MRI. Nineteen patients (8.2%) died during a median follow-up of 1.7 years (interquartile range 1.1 to 2.9). Cox proportional hazards analysis revealed that infarct size defined as spatial extent (hazard ratio [HR] 1.3, 95% confidence interval [CI] 1.1 to 1.6, chi-square 6.7, p = 0.010), transmurality (HR 1.5, 9 5% CI 1.1 to 1.9, chi-square 8.9, p = 0.003), or total scar score (HR 6.2, 95% Cl 1.7 to 23, chi-square 7.4, p = 0.006) were stronger predictors of all-cause mortality than LVEF and I-V volumes. In conclusion, infarct size on contrast-enhanced MRI may be superior to LVEF and LV volumes for predicting long-term mortality in patients with healed myocardial infarction. (c) 2007 Elsevier Inc. All rights reserved.