• 作者：Pilar Merlos ; Maria P. L¨®pez-Lereu ; Jose V. Monmeneu ; Juan Sanchis ; Julio N¨²?ez ; Clara Bonanad ; Ernesto Valero ; Gema Mi?ana ; Fabi¨¢n Chaustre ; Cristina G¨®mez ; Ricardo Oltra ; Lorena Palacios ; Maria J. Bosch ; Vicente Navarro ; Angel Ll¨¢cer ; Francisco J. Chorro ; Vicente Bod¨ª
• 关键词：AMP ; anomalí ; as del movimiento de la pared ; ENT ; extensió ; n de la necrosis transmural ; FEVI ; fracció ; n de eyecció ; n del ventrí ; culo izquierdo ; IAMCEST ; infarto agudo de miocardio con elevació ; n del segmento ST ; MACE ; ev
• 刊名：Revista Espa?ola de Cardiologa
• 出版年：2013
• 出版时间：August, 2013
• 年：2013
• 卷：66
• 期：8
• 页码：613-622
• 全文大小：815 K

Introduction and objectives

A variety of cardiac magnetic resonance indexes predict mid-term prognosis in ST-segment elevation myocardial infarction patients. The extent of transmural necrosis permits simple and accurate prediction of systolic recovery. However, its long-term prognostic value beyond a comprehensive clinical and cardiac magnetic resonance evaluation is unknown. We hypothesized that a simple semiquantitative assessment of the extent of transmural necrosis is the best resonance index to predict long-term outcome soon after a first ST-segment elevation myocardial infarction.

Methods

One week after a first ST-segment elevation myocardial infarction we carried out a comprehensive quantification of several resonance parameters in 206 consecutive patients. A semiquantitative assessment (altered number of segments in the 17-segment model) of edema, baseline and post-dobutamine wall motion abnormalities, first pass perfusion, microvascular obstruction, and the extent of transmural necrosis was also performed.

Results

During follow-up (median 51 months), 29 patients suffered a major adverse cardiac event (8 cardiac deaths, 11 nonfatal myocardial infarctions, and 10 readmissions for heart failure). Major cardiac events were associated with more severely altered quantitative and semiquantitative resonance indexes. After a comprehensive multivariate adjustment, the extent of transmural necrosis was the only resonance index independently related to the major cardiac event rate (hazard ratio=1.34 [1.19-1.51] per each additional segment displaying >50 % transmural necrosis, P<.001).

Conclusions

A simple and non-time consuming semiquantitative analysis of the extent of transmural necrosis is the most powerful cardiac magnetic resonance index to predict long-term outcome soon after a first ST-segment elevation myocardial infarction.

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