A comparison of infarct mass by cardiac magnetic resonance and real time myocardial perfusion echocardiography as predictors of major adverse cardiac events following reperfusion for ST elevation myocardial infarction

Charles J. Lenz, Sahar S. Abdelmoneim, Nandan S. Anavekar, Thomas A. Foley, Lara F. Nhola, Runqing Huang, Jae Kuen Oh, Sharon L. Mulvagh

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Purpose: Infarct mass as assessed by myocardial-delayed enhancement imaging on cardiac magnetic resonance (CMR) and myocardial blood flow as assessed by real time myocardial perfusion echocardiography (RT-MPE) have been shown to predict adverse events following ST elevation myocardial infarction (STEMI). There has been no published comparison of quantitative assessment using these modalities as predictors of clinical outcomes to date. We compared RT-MPE with CMR for prediction of cardiac events in reperfused STEMI patients. Materials and Methods: Consecutive STEMI patients with early reperfusion were studied. RT-MPE and CMR were performed. Perfusion score indices (PSIRT - MPE and PSICMR) were calculated [sum of segmental perfusion scores/number of segments]. CMR infarct mass (g) and RT-MPE myocardial blood flow (MBF dB/s) were quantified. Patients were followed for cardiac events (death, nonfatal MI, revascularization, angina, and heart failure). Results: All 27 patients (age 62±14; follow-up 3.5±2.6 years) had thrombolysis in myocardial infarction (TIMI) grade 3 flow of infarct vessel. Cardiac events occurred in 17 (63%). Cardiac event patients had higher PSIRT - MPE, PSICMR, infarct mass, and lower MBF. PSIRT - MPE cutoff of 0.3 had an AUC of 0.856 (82% sensitivity, 70% specificity), while a PSICMR cutoff of 0.2 had an AUC of 0.765 (76% sensitivity, 60% specificity). Infarct mass and MBF were independent predictors of cardiac events after adjusting for risk factors (hazard ratios: 20.9 [95% CI 1.8–256] P=.02 and 8.1 [95% CI 1.5–78] P=.01, respectively). Conclusions: Quantitative RT-MPE performed comparably to CMR for prediction of MACE in STEMI patients supporting a prognostic role for this noninvasive, bedside imaging method.

Original languageEnglish (US)
Pages (from-to)1539-1545
Number of pages7
JournalEchocardiography
Volume33
Issue number10
DOIs
StatePublished - Oct 1 2016

Fingerprint

Reperfusion
Echocardiography
Magnetic Resonance Spectroscopy
Perfusion
Area Under Curve
Sensitivity and Specificity
ST Elevation Myocardial Infarction
Heart Failure
Myocardial Infarction

Keywords

  • major adverse cardiac events
  • microvascular obstruction
  • outcomes research
  • perfusion imaging
  • prognosis
  • ST elevation myocardial infarction

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

A comparison of infarct mass by cardiac magnetic resonance and real time myocardial perfusion echocardiography as predictors of major adverse cardiac events following reperfusion for ST elevation myocardial infarction. / Lenz, Charles J.; Abdelmoneim, Sahar S.; Anavekar, Nandan S.; Foley, Thomas A.; Nhola, Lara F.; Huang, Runqing; Oh, Jae Kuen; Mulvagh, Sharon L.

In: Echocardiography, Vol. 33, No. 10, 01.10.2016, p. 1539-1545.

Research output: Contribution to journalArticle

Lenz, Charles J. ; Abdelmoneim, Sahar S. ; Anavekar, Nandan S. ; Foley, Thomas A. ; Nhola, Lara F. ; Huang, Runqing ; Oh, Jae Kuen ; Mulvagh, Sharon L. / A comparison of infarct mass by cardiac magnetic resonance and real time myocardial perfusion echocardiography as predictors of major adverse cardiac events following reperfusion for ST elevation myocardial infarction. In: Echocardiography. 2016 ; Vol. 33, No. 10. pp. 1539-1545.
@article{df006cf0d4fa4a46ba97466fd7a1053a,
title = "A comparison of infarct mass by cardiac magnetic resonance and real time myocardial perfusion echocardiography as predictors of major adverse cardiac events following reperfusion for ST elevation myocardial infarction",
abstract = "Purpose: Infarct mass as assessed by myocardial-delayed enhancement imaging on cardiac magnetic resonance (CMR) and myocardial blood flow as assessed by real time myocardial perfusion echocardiography (RT-MPE) have been shown to predict adverse events following ST elevation myocardial infarction (STEMI). There has been no published comparison of quantitative assessment using these modalities as predictors of clinical outcomes to date. We compared RT-MPE with CMR for prediction of cardiac events in reperfused STEMI patients. Materials and Methods: Consecutive STEMI patients with early reperfusion were studied. RT-MPE and CMR were performed. Perfusion score indices (PSIRT - MPE and PSICMR) were calculated [sum of segmental perfusion scores/number of segments]. CMR infarct mass (g) and RT-MPE myocardial blood flow (MBF dB/s) were quantified. Patients were followed for cardiac events (death, nonfatal MI, revascularization, angina, and heart failure). Results: All 27 patients (age 62±14; follow-up 3.5±2.6 years) had thrombolysis in myocardial infarction (TIMI) grade 3 flow of infarct vessel. Cardiac events occurred in 17 (63{\%}). Cardiac event patients had higher PSIRT - MPE, PSICMR, infarct mass, and lower MBF. PSIRT - MPE cutoff of 0.3 had an AUC of 0.856 (82{\%} sensitivity, 70{\%} specificity), while a PSICMR cutoff of 0.2 had an AUC of 0.765 (76{\%} sensitivity, 60{\%} specificity). Infarct mass and MBF were independent predictors of cardiac events after adjusting for risk factors (hazard ratios: 20.9 [95{\%} CI 1.8–256] P=.02 and 8.1 [95{\%} CI 1.5–78] P=.01, respectively). Conclusions: Quantitative RT-MPE performed comparably to CMR for prediction of MACE in STEMI patients supporting a prognostic role for this noninvasive, bedside imaging method.",
keywords = "major adverse cardiac events, microvascular obstruction, outcomes research, perfusion imaging, prognosis, ST elevation myocardial infarction",
author = "Lenz, {Charles J.} and Abdelmoneim, {Sahar S.} and Anavekar, {Nandan S.} and Foley, {Thomas A.} and Nhola, {Lara F.} and Runqing Huang and Oh, {Jae Kuen} and Mulvagh, {Sharon L.}",
year = "2016",
month = "10",
day = "1",
doi = "10.1111/echo.13308",
language = "English (US)",
volume = "33",
pages = "1539--1545",
journal = "Echocardiography",
issn = "0742-2822",
publisher = "Wiley-Blackwell",
number = "10",

}

TY - JOUR

T1 - A comparison of infarct mass by cardiac magnetic resonance and real time myocardial perfusion echocardiography as predictors of major adverse cardiac events following reperfusion for ST elevation myocardial infarction

AU - Lenz, Charles J.

AU - Abdelmoneim, Sahar S.

AU - Anavekar, Nandan S.

AU - Foley, Thomas A.

AU - Nhola, Lara F.

AU - Huang, Runqing

AU - Oh, Jae Kuen

AU - Mulvagh, Sharon L.

PY - 2016/10/1

Y1 - 2016/10/1

N2 - Purpose: Infarct mass as assessed by myocardial-delayed enhancement imaging on cardiac magnetic resonance (CMR) and myocardial blood flow as assessed by real time myocardial perfusion echocardiography (RT-MPE) have been shown to predict adverse events following ST elevation myocardial infarction (STEMI). There has been no published comparison of quantitative assessment using these modalities as predictors of clinical outcomes to date. We compared RT-MPE with CMR for prediction of cardiac events in reperfused STEMI patients. Materials and Methods: Consecutive STEMI patients with early reperfusion were studied. RT-MPE and CMR were performed. Perfusion score indices (PSIRT - MPE and PSICMR) were calculated [sum of segmental perfusion scores/number of segments]. CMR infarct mass (g) and RT-MPE myocardial blood flow (MBF dB/s) were quantified. Patients were followed for cardiac events (death, nonfatal MI, revascularization, angina, and heart failure). Results: All 27 patients (age 62±14; follow-up 3.5±2.6 years) had thrombolysis in myocardial infarction (TIMI) grade 3 flow of infarct vessel. Cardiac events occurred in 17 (63%). Cardiac event patients had higher PSIRT - MPE, PSICMR, infarct mass, and lower MBF. PSIRT - MPE cutoff of 0.3 had an AUC of 0.856 (82% sensitivity, 70% specificity), while a PSICMR cutoff of 0.2 had an AUC of 0.765 (76% sensitivity, 60% specificity). Infarct mass and MBF were independent predictors of cardiac events after adjusting for risk factors (hazard ratios: 20.9 [95% CI 1.8–256] P=.02 and 8.1 [95% CI 1.5–78] P=.01, respectively). Conclusions: Quantitative RT-MPE performed comparably to CMR for prediction of MACE in STEMI patients supporting a prognostic role for this noninvasive, bedside imaging method.

AB - Purpose: Infarct mass as assessed by myocardial-delayed enhancement imaging on cardiac magnetic resonance (CMR) and myocardial blood flow as assessed by real time myocardial perfusion echocardiography (RT-MPE) have been shown to predict adverse events following ST elevation myocardial infarction (STEMI). There has been no published comparison of quantitative assessment using these modalities as predictors of clinical outcomes to date. We compared RT-MPE with CMR for prediction of cardiac events in reperfused STEMI patients. Materials and Methods: Consecutive STEMI patients with early reperfusion were studied. RT-MPE and CMR were performed. Perfusion score indices (PSIRT - MPE and PSICMR) were calculated [sum of segmental perfusion scores/number of segments]. CMR infarct mass (g) and RT-MPE myocardial blood flow (MBF dB/s) were quantified. Patients were followed for cardiac events (death, nonfatal MI, revascularization, angina, and heart failure). Results: All 27 patients (age 62±14; follow-up 3.5±2.6 years) had thrombolysis in myocardial infarction (TIMI) grade 3 flow of infarct vessel. Cardiac events occurred in 17 (63%). Cardiac event patients had higher PSIRT - MPE, PSICMR, infarct mass, and lower MBF. PSIRT - MPE cutoff of 0.3 had an AUC of 0.856 (82% sensitivity, 70% specificity), while a PSICMR cutoff of 0.2 had an AUC of 0.765 (76% sensitivity, 60% specificity). Infarct mass and MBF were independent predictors of cardiac events after adjusting for risk factors (hazard ratios: 20.9 [95% CI 1.8–256] P=.02 and 8.1 [95% CI 1.5–78] P=.01, respectively). Conclusions: Quantitative RT-MPE performed comparably to CMR for prediction of MACE in STEMI patients supporting a prognostic role for this noninvasive, bedside imaging method.

KW - major adverse cardiac events

KW - microvascular obstruction

KW - outcomes research

KW - perfusion imaging

KW - prognosis

KW - ST elevation myocardial infarction

UR - http://www.scopus.com/inward/record.url?scp=84992470004&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84992470004&partnerID=8YFLogxK

U2 - 10.1111/echo.13308

DO - 10.1111/echo.13308

M3 - Article

C2 - 27546353

AN - SCOPUS:84992470004

VL - 33

SP - 1539

EP - 1545

JO - Echocardiography

JF - Echocardiography

SN - 0742-2822

IS - 10

ER -