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

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. M...

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Autores principales:	Gianluca Di Bella, Giovanni Donato Aquaro, Jan Bogaert, Paolo Piaggi, Antonio Micari, Fausto Pizzino, Giovanni Camastra, Scipione Carerj, Mariapaola Campisi, Antonio Bracco, Maria Ludovica Carerj, Michele Emdin, Bijoy K. Khandheria, Alessandro Pingitore
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Contractile segmental function Myocardial infarction Myocardial viability Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/6caf0f23b5864c69870e518d3be0ebe5
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spelling	oai:doaj.org-article:6caf0f23b5864c69870e518d3be0ebe52021-11-07T12:21:49ZNon-transmural myocardial infarction associated with regional contractile function is an independent predictor of positive outcome: an integrated approach to myocardial viability10.1186/s12968-021-00818-01532-429Xhttps://doaj.org/article/6caf0f23b5864c69870e518d3be0ebe52021-11-01T00:00:00Zhttps://doi.org/10.1186/s12968-021-00818-0https://doaj.org/toc/1532-429XAbstract 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.Gianluca Di BellaGiovanni Donato AquaroJan BogaertPaolo PiaggiAntonio MicariFausto PizzinoGiovanni CamastraScipione CarerjMariapaola CampisiAntonio BraccoMaria Ludovica CarerjMichele EmdinBijoy K. KhandheriaAlessandro PingitoreBMCarticleContractile segmental functionMyocardial infarctionMyocardial viabilityDiseases of the circulatory (Cardiovascular) systemRC666-701ENJournal of Cardiovascular Magnetic Resonance, Vol 23, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Contractile segmental function Myocardial infarction Myocardial viability Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	Contractile segmental function Myocardial infarction Myocardial viability Diseases of the circulatory (Cardiovascular) system RC666-701 Gianluca Di Bella Giovanni Donato Aquaro Jan Bogaert Paolo Piaggi Antonio Micari Fausto Pizzino Giovanni Camastra Scipione Carerj Mariapaola Campisi Antonio Bracco Maria Ludovica Carerj Michele Emdin Bijoy K. Khandheria Alessandro Pingitore Non-transmural myocardial infarction associated with regional contractile function is an independent predictor of positive outcome: an integrated approach to myocardial viability
description	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.
format	article
author	Gianluca Di Bella Giovanni Donato Aquaro Jan Bogaert Paolo Piaggi Antonio Micari Fausto Pizzino Giovanni Camastra Scipione Carerj Mariapaola Campisi Antonio Bracco Maria Ludovica Carerj Michele Emdin Bijoy K. Khandheria Alessandro Pingitore
author_facet	Gianluca Di Bella Giovanni Donato Aquaro Jan Bogaert Paolo Piaggi Antonio Micari Fausto Pizzino Giovanni Camastra Scipione Carerj Mariapaola Campisi Antonio Bracco Maria Ludovica Carerj Michele Emdin Bijoy K. Khandheria Alessandro Pingitore
author_sort	Gianluca Di Bella
title	Non-transmural myocardial infarction associated with regional contractile function is an independent predictor of positive outcome: an integrated approach to myocardial viability
title_short	Non-transmural myocardial infarction associated with regional contractile function is an independent predictor of positive outcome: an integrated approach to myocardial viability
title_full	Non-transmural myocardial infarction associated with regional contractile function is an independent predictor of positive outcome: an integrated approach to myocardial viability
title_fullStr	Non-transmural myocardial infarction associated with regional contractile function is an independent predictor of positive outcome: an integrated approach to myocardial viability
title_full_unstemmed	Non-transmural myocardial infarction associated with regional contractile function is an independent predictor of positive outcome: an integrated approach to myocardial viability
title_sort	non-transmural myocardial infarction associated with regional contractile function is an independent predictor of positive outcome: an integrated approach to myocardial viability
publisher	BMC
publishDate	2021
url	https://doaj.org/article/6caf0f23b5864c69870e518d3be0ebe5
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Non-transmural myocardial infarction associated with regional contractile function is an independent predictor of positive outcome: an integrated approach to myocardial viability

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