Institution: | 1. Department of Otorhinolaryngology & Head Neck Surgery, Hamdard Institute of Medical Sciences & Research and HAH Centenary Hospital, Jamia Hamdard, Delhi, India;2. Department of Pathology, Hamdard Institute of Medical Sciences & Research and HAH Centenary Hospital, Jamia Hamdard, Delhi, India;1. Department of Medical Sciences, Uppsala University, Uppsala, Sweden;2. Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden;3. Christchurch Hospital, Christchurch, New Zealand;4. Royal Brisbane and Women''s Hospital, Brisbane, Australia;5. University of Queensland, Brisbane, Australia;6. University of Otago Christchurch, Christchurch, New Zealand;7. University of Technology, Brisbane, Australia |
Abstract: | ObjectivesInfarct size is a major surrogate marker for prognosis in the context of myocardial infarction. There is a growing interest in validating a quantitative assessment approach in order to: (1) standardize these analyses; (2) to precise the individual prognosis of our patients. Several methods are available and were tested across their capacity to predict left ventricular (LV) remodeling at three months.Patients and methodsLate gadolinium enhancement-MRI was performed on day 5 and after a period of three months in 92 patients with STEMI. LV volumes and scar parameters were assessed visually (by using a four scale score) and quantitatively on day 5 and at three months. Dichotomous thresholds were defined first visually (VISUAL), then by 2, 5 and 6 standard deviations above remote myocardium, and by the full-width at half-maximum (FWHM) method.ResultsAll infarct sizing methods showed great relation to LV remodeling at three months (ROC analysis). Univariate predictors of an LV end-systolic volume index (LVESVi) superior to 70 mL/m2 were: heart failure, creatin kinase peak and infarct size at day 5. FWHM was shown to be the best of all quantitative methods. An infarct size superior to 44 grams predicted a LVESVi > 70 mL/m2 with a sensitivity of 90% and a specificity of 92.5%. FWHM reproducibility was good (r = 0.895, P < 0.0001, Bland Altman bias of 0.8 g).ConclusionIn the context of STEMI, FWHM is a tough and reproducible algorithm to quantitatively assess late gadolinium hyperenhancement, greatly related to functional prognosis at three months follow-up. |