Epicardial Surface Area of Infarction: A Stable Surrogate of Microvascular Obstruction in Acute Myocardial Infarction.
作者信息
Smulders Martijn W, Van Assche Lowie M R, Bekkers Sebastiaan C A M, Nijveldt Robin, Beijnink Casper W H, Kim Han W, Hayes Brenda, Parker Michele A, Kaolawanich Yodying, Judd Robert M, Kim Raymond J
机构信息
Department of Cardiology, Maastricht University Medical Center, the Netherlands (M.W.S., S.C.A.M.B.).
Duke Cardiovascular Magnetic Resonance Center, Department of Medicine and Radiology, Duke University Medical Center, Durham, NC (L.M.R.V.A., H.W.K., B.H., M.A.P., Y.K., R.M.J., R.J.K.).
出版信息
Circ Cardiovasc Imaging. 2021 Feb;14(2):e010918. doi: 10.1161/CIRCIMAGING.120.010918. Epub 2021 Feb 15.
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 (<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%, =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.
Zotero 插件