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Defining left ventricular remodeling following acute ST-segment elevation myocardial infarction using cardiovascular magnetic resonance

BACKGROUND: The assessment of post-myocardial infarction (MI) left ventricular (LV) remodeling by cardiovascular magnetic resonance (CMR) currently uses criteria defined by echocardiography. Our aim was to provide CMR criteria for assessing LV remodeling following acute MI. METHODS: Firstly, 40 repe...

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Autores principales: Bulluck, Heerajnarain, Go, Yun Yun, Crimi, Gabriele, Ludman, Andrew J., Rosmini, Stefania, Abdel-Gadir, Amna, Bhuva, Anish N., Treibel, Thomas A., Fontana, Marianna, Pica, Silvia, Raineri, Claudia, Sirker, Alex, Herrey, Anna S., Manisty, Charlotte, Groves, Ashley, Moon, James C., Hausenloy, Derek J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5346848/
https://www.ncbi.nlm.nih.gov/pubmed/28285594
http://dx.doi.org/10.1186/s12968-017-0343-9
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author Bulluck, Heerajnarain
Go, Yun Yun
Crimi, Gabriele
Ludman, Andrew J.
Rosmini, Stefania
Abdel-Gadir, Amna
Bhuva, Anish N.
Treibel, Thomas A.
Fontana, Marianna
Pica, Silvia
Raineri, Claudia
Sirker, Alex
Herrey, Anna S.
Manisty, Charlotte
Groves, Ashley
Moon, James C.
Hausenloy, Derek J.
author_facet Bulluck, Heerajnarain
Go, Yun Yun
Crimi, Gabriele
Ludman, Andrew J.
Rosmini, Stefania
Abdel-Gadir, Amna
Bhuva, Anish N.
Treibel, Thomas A.
Fontana, Marianna
Pica, Silvia
Raineri, Claudia
Sirker, Alex
Herrey, Anna S.
Manisty, Charlotte
Groves, Ashley
Moon, James C.
Hausenloy, Derek J.
author_sort Bulluck, Heerajnarain
collection PubMed
description BACKGROUND: The assessment of post-myocardial infarction (MI) left ventricular (LV) remodeling by cardiovascular magnetic resonance (CMR) currently uses criteria defined by echocardiography. Our aim was to provide CMR criteria for assessing LV remodeling following acute MI. METHODS: Firstly, 40 reperfused ST-segment elevation myocardial infarction (STEMI) patients with paired acute (4 ± 2 days) and follow-up (5 ± 2 months) CMR scans were analyzed by 2 independent reviewers and the minimal detectable changes (MDCs) for percentage change in LV end-diastolic volume (%ΔLVEDV), LV end-systolic volume (%ΔLVESV), and LV ejection fraction (%ΔLVEF) between the acute and follow-up scans were determined. Secondly, in 146 reperfused STEMI patients, receiver operator characteristic curve analyses for predicting LVEF <50% at follow-up (as a surrogate for clinical poor clinical outcome) were undertaken to obtain cut-off values for %ΔLVEDV and %ΔLVESV. RESULTS: The MDCs for %ΔLVEDV, %ΔLVESV, and %ΔLVEF were similar at 12%, 12%, 13%, respectively. The cut-off values for predicting LVEF < 50% at follow-up were 11% for %ΔLVEDV on receiver operating characteristic curve analysis (area under the curve (AUC) 0.75, 95% CI 0.6 to 0.83, sensitivity 72% specificity 70%), and 5% for %ΔLVESV (AUC 0.83, 95% CI 0.77 to 0.90, sensitivity and specificity 78%). Using cut-off MDC values (higher than the clinically important cut-off values) of 12% for both %ΔLVEDV and %ΔLVESV, 4 main patterns of LV remodeling were identified in our cohort: reverse LV remodeling (LVEF predominantly improved); no LV remodeling (LVEF predominantly unchanged); adverse LV remodeling with compensation (LVEF predominantly improved); and adverse LV remodeling (LVEF unchanged or worsened). CONCLUSIONS: The MDCs for %ΔLVEDV and %ΔLVESV between the acute and follow-up CMR scans of 12% each may be used to define adverse or reverse LV remodeling post-STEMI. The MDC for %ΔLVEF of 13%, relative to baseline, provides the minimal effect size required for investigating treatments aimed at improving LVEF following acute STEMI. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12968-017-0343-9) contains supplementary material, which is available to authorized users.
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spelling pubmed-53468482017-03-14 Defining left ventricular remodeling following acute ST-segment elevation myocardial infarction using cardiovascular magnetic resonance Bulluck, Heerajnarain Go, Yun Yun Crimi, Gabriele Ludman, Andrew J. Rosmini, Stefania Abdel-Gadir, Amna Bhuva, Anish N. Treibel, Thomas A. Fontana, Marianna Pica, Silvia Raineri, Claudia Sirker, Alex Herrey, Anna S. Manisty, Charlotte Groves, Ashley Moon, James C. Hausenloy, Derek J. J Cardiovasc Magn Reson Research BACKGROUND: The assessment of post-myocardial infarction (MI) left ventricular (LV) remodeling by cardiovascular magnetic resonance (CMR) currently uses criteria defined by echocardiography. Our aim was to provide CMR criteria for assessing LV remodeling following acute MI. METHODS: Firstly, 40 reperfused ST-segment elevation myocardial infarction (STEMI) patients with paired acute (4 ± 2 days) and follow-up (5 ± 2 months) CMR scans were analyzed by 2 independent reviewers and the minimal detectable changes (MDCs) for percentage change in LV end-diastolic volume (%ΔLVEDV), LV end-systolic volume (%ΔLVESV), and LV ejection fraction (%ΔLVEF) between the acute and follow-up scans were determined. Secondly, in 146 reperfused STEMI patients, receiver operator characteristic curve analyses for predicting LVEF <50% at follow-up (as a surrogate for clinical poor clinical outcome) were undertaken to obtain cut-off values for %ΔLVEDV and %ΔLVESV. RESULTS: The MDCs for %ΔLVEDV, %ΔLVESV, and %ΔLVEF were similar at 12%, 12%, 13%, respectively. The cut-off values for predicting LVEF < 50% at follow-up were 11% for %ΔLVEDV on receiver operating characteristic curve analysis (area under the curve (AUC) 0.75, 95% CI 0.6 to 0.83, sensitivity 72% specificity 70%), and 5% for %ΔLVESV (AUC 0.83, 95% CI 0.77 to 0.90, sensitivity and specificity 78%). Using cut-off MDC values (higher than the clinically important cut-off values) of 12% for both %ΔLVEDV and %ΔLVESV, 4 main patterns of LV remodeling were identified in our cohort: reverse LV remodeling (LVEF predominantly improved); no LV remodeling (LVEF predominantly unchanged); adverse LV remodeling with compensation (LVEF predominantly improved); and adverse LV remodeling (LVEF unchanged or worsened). CONCLUSIONS: The MDCs for %ΔLVEDV and %ΔLVESV between the acute and follow-up CMR scans of 12% each may be used to define adverse or reverse LV remodeling post-STEMI. The MDC for %ΔLVEF of 13%, relative to baseline, provides the minimal effect size required for investigating treatments aimed at improving LVEF following acute STEMI. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12968-017-0343-9) contains supplementary material, which is available to authorized users. BioMed Central 2017-03-13 /pmc/articles/PMC5346848/ /pubmed/28285594 http://dx.doi.org/10.1186/s12968-017-0343-9 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Bulluck, Heerajnarain
Go, Yun Yun
Crimi, Gabriele
Ludman, Andrew J.
Rosmini, Stefania
Abdel-Gadir, Amna
Bhuva, Anish N.
Treibel, Thomas A.
Fontana, Marianna
Pica, Silvia
Raineri, Claudia
Sirker, Alex
Herrey, Anna S.
Manisty, Charlotte
Groves, Ashley
Moon, James C.
Hausenloy, Derek J.
Defining left ventricular remodeling following acute ST-segment elevation myocardial infarction using cardiovascular magnetic resonance
title Defining left ventricular remodeling following acute ST-segment elevation myocardial infarction using cardiovascular magnetic resonance
title_full Defining left ventricular remodeling following acute ST-segment elevation myocardial infarction using cardiovascular magnetic resonance
title_fullStr Defining left ventricular remodeling following acute ST-segment elevation myocardial infarction using cardiovascular magnetic resonance
title_full_unstemmed Defining left ventricular remodeling following acute ST-segment elevation myocardial infarction using cardiovascular magnetic resonance
title_short Defining left ventricular remodeling following acute ST-segment elevation myocardial infarction using cardiovascular magnetic resonance
title_sort defining left ventricular remodeling following acute st-segment elevation myocardial infarction using cardiovascular magnetic resonance
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5346848/
https://www.ncbi.nlm.nih.gov/pubmed/28285594
http://dx.doi.org/10.1186/s12968-017-0343-9
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