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Myocardial Salvage by CMR Correlates With LV Remodeling and Early ST-Segment Resolution in Acute Myocardial Infarction

Pier Giorgio Masci, MD^_*,_*, Javier Ganame, MD, PhD^,, Elisabetta Strata, MD^_*, Walter Desmet, MD, Giovanni Donato Aquaro, MD^_*, Steven Dymarkowski, MD, PhD, Valentina Valenti, MD, Stefan Janssens, MD, PhD, Massimo Lombardi, MD^_*, Frans Van de Werf, MD, PhD, Antonio L'Abbate, MD^||, Jan Bogaert, MD, PhD

^_* MRI Unit, G. Monasterio Foundation/CNR–Regione Toscana, Pisa, Italy
Radiology Department, University Hospitals Leuven, Leuven, Belgium
Cardiology Department, University Hospitals Leuven, Leuven, Belgium
La Sapienza University, Rome, Italy
^|| Scuola Superiore Sant' Anna, Pisa, Italy

^_* Reprint requests and correspondence: Dr. Pier Giorgio Masci, MRI Unit, G. Monasterio Foundation, CNR–Regione Toscana, Via Giuseppe Moruzzi 1, 56124 Pisa, Italy (Email: pgmasci{at}tiscali.it).

Objectives: The purpose of this study was to assess the association of myocardial salvage by cardiac magnetic resonance (CMR) with left ventricular (LV) remodeling and early ST-segment resolution in patients with acute myocardial infarction (MI).

Background: Experimental studies revealed that MI size is strongly influenced by the extent of the area at risk (AAR), limiting its accuracy as a marker of reperfusion treatment efficacy in acute MI studies. Hence, an index correcting MI size for AAR extent is warranted. T2-weighted CMR and delayed-enhancement CMR, respectively, enable the determination of AAR and MI size, and the myocardial salvage index (MSI) is calculated by correcting MI size for AAR extent. Nevertheless, the clinical value of CMR-derived MSI has not been evaluated yet.

Methods: In a prospective cohort of 137 consecutive patients with acutely reperfused ST-segment elevation MI, CMR was performed at 1 week and 4 months. T2-weighted CMR was used to quantify AAR, whereas MI size was detected by delayed-enhancement imaging. MSI was defined as AAR extent minus MI size divided by AAR extent. Adverse LV remodeling was defined as an increase in LV end-systolic volume of 15%. The degree of ST-segment resolution 1 h after reperfusion was also calculated.

Results: AAR extent was consistently larger than MI size (32 ± 15% of LV vs. 18 ± 13% of LV, p < 0.0001), yielding an MSI of 0.46 ± 0.24. MI size was closely related to AAR extent (r = 0.81, p < 0.0001). After correction for the main baseline characteristics by multivariate analyses, MSI was a major and independent determinant of adverse LV remodeling (odds ratio: 0.64; 95% confidence interval: 0.49 to 0.84, p = 0.001) and was independently associated with early ST-segment resolution (B coefficient = 0.61, p < 0.0001).

Conclusions: In patients with reperfused ST-segment elevation MI, CMR-derived MSI is independently associated with adverse LV remodeling and early ST-segment resolution, opening new perspectives on its use in studies testing novel reperfusion strategies.

Key Words: area at risk • cardiovascular magnetic resonance • myocardial infarction • myocardial salvage

Abbreviations and Acronyms   AAR = area at risk   CMR = cardiac magnetic resonance   DE = delayed enhancement   ECG = electrocardiogram   FOV = field of view   LV = left ventricular   MI = myocardial infarction   MO = microvascular obstruction   MSI = myocardial salvage index   SI = signal intensity

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