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Sub-acute cardiac magnetic resonance to predict irreversible reduction in left ventricular ejection fraction after ST-segment elevation myocardial infarction : A DANAMI-3 sub-study

Alzuhairi, Karam Sadoon ; Lønborg, Jacob ; Ahtarovski, Kiril Aleksov ; Nepper-Christensen, Lars ; Kyhl, Kasper ; Lassen, Jens F. ; Sørensen, Rikke ; Joshi, Francis ; Ghotbi, Adam Ali and Schoos, Mikkel , et al. (2020) In International Journal of Cardiology 301. p.215-219
Abstract

Aims: To predict irreversible reduction in left ventricular ejection fraction (LVEF) during admission for ST-segment elevation myocardial infarction (STEMI) using cardiac magnetic resonance (CMR) in addition to classical clinical parameters. Irreversible reduction in LVEF is an important prognostic factor after STEMI which necessitates medical therapy and implantation of prophylactic implantable cardioverter defibrillator (ICD). Methods and results: A post-hoc analysis of DANAMI-3 trial program (Third DANish Study of Optimal Acute Treatment of Patients With ST-elevation Myocardial Infarction) which recruited 649 patients who had CMR performed during index hospitalization and after 3 months. Patients were divided into two groups... (More)

Aims: To predict irreversible reduction in left ventricular ejection fraction (LVEF) during admission for ST-segment elevation myocardial infarction (STEMI) using cardiac magnetic resonance (CMR) in addition to classical clinical parameters. Irreversible reduction in LVEF is an important prognostic factor after STEMI which necessitates medical therapy and implantation of prophylactic implantable cardioverter defibrillator (ICD). Methods and results: A post-hoc analysis of DANAMI-3 trial program (Third DANish Study of Optimal Acute Treatment of Patients With ST-elevation Myocardial Infarction) which recruited 649 patients who had CMR performed during index hospitalization and after 3 months. Patients were divided into two groups according to CMR-LVEF at 3 months: Group 1 with LVEF≤35% and Group 2 with LVEF>35%. Group 1 included 15 patients (2.3%) while Group 2 included 634 patients (97.7%). A multivariate analysis showed that: Killip class >1 (OR 7.39; CI:1.47–36.21, P = 0.01), symptom onset-to-wire ≥6 h (OR 7.19; CI 1.07–50.91, P = 0.04), LVEF≤35% using index echocardiography (OR 7.11; CI: 1.27–47.43, P = 0.03), and infarct size ≥40% of LV on index CMR (OR 42.62; CI:7.83–328.29, P < 0.001) independently correlated with a final LVEF≤35%. Clinical models consisted of these parameters could identify 7 out of 15 patients in Group 1 with 100% positive predictive value. Conclusion: Together with other clinical measurements, the assessment of infarct size using late Gadolinium enhancement by CMR during hospitalization is a strong predictor of irreversible reduction in CMR_LVEF ≤35. That could potentially, after validation with future research, aids the selection and treatment of high-risk patients after STEMI, including implantation of prophylactic ICD during index hospitalization.

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published
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keywords
Cardiac MRI, Prophylactic ICD, Reduced LVEF, STEMI
in
International Journal of Cardiology
volume
301
pages
5 pages
publisher
Elsevier
external identifiers
  • scopus:85075400701
  • pmid:31748187
ISSN
0167-5273
DOI
10.1016/j.ijcard.2019.10.034
language
English
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yes
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2f028954-5593-4e8b-bd96-3c4550c38669
date added to LUP
2019-12-10 13:49:58
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2020-02-15 04:30:00
@article{2f028954-5593-4e8b-bd96-3c4550c38669,
  abstract     = {<p>Aims: To predict irreversible reduction in left ventricular ejection fraction (LVEF) during admission for ST-segment elevation myocardial infarction (STEMI) using cardiac magnetic resonance (CMR) in addition to classical clinical parameters. Irreversible reduction in LVEF is an important prognostic factor after STEMI which necessitates medical therapy and implantation of prophylactic implantable cardioverter defibrillator (ICD). Methods and results: A post-hoc analysis of DANAMI-3 trial program (Third DANish Study of Optimal Acute Treatment of Patients With ST-elevation Myocardial Infarction) which recruited 649 patients who had CMR performed during index hospitalization and after 3 months. Patients were divided into two groups according to CMR-LVEF at 3 months: Group 1 with LVEF≤35% and Group 2 with LVEF&gt;35%. Group 1 included 15 patients (2.3%) while Group 2 included 634 patients (97.7%). A multivariate analysis showed that: Killip class &gt;1 (OR 7.39; CI:1.47–36.21, P = 0.01), symptom onset-to-wire ≥6 h (OR 7.19; CI 1.07–50.91, P = 0.04), LVEF≤35% using index echocardiography (OR 7.11; CI: 1.27–47.43, P = 0.03), and infarct size ≥40% of LV on index CMR (OR 42.62; CI:7.83–328.29, P &lt; 0.001) independently correlated with a final LVEF≤35%. Clinical models consisted of these parameters could identify 7 out of 15 patients in Group 1 with 100% positive predictive value. Conclusion: Together with other clinical measurements, the assessment of infarct size using late Gadolinium enhancement by CMR during hospitalization is a strong predictor of irreversible reduction in CMR_LVEF ≤35. That could potentially, after validation with future research, aids the selection and treatment of high-risk patients after STEMI, including implantation of prophylactic ICD during index hospitalization.</p>},
  author       = {Alzuhairi, Karam Sadoon and Lønborg, Jacob and Ahtarovski, Kiril Aleksov and Nepper-Christensen, Lars and Kyhl, Kasper and Lassen, Jens F. and Sørensen, Rikke and Joshi, Francis and Ghotbi, Adam Ali and Schoos, Mikkel and Goransson, Christoffer and Bertelsen, Litten and Helqvist, Steffen and Holmvang, Lene and Jørgensen, Erik and Pedersen, Frants and Tilsted, Hans Henrik and Høfsten, Dan and Køber, Lars and Kelbæk, Henning and Vejlstrup, Niels and Engstrøm, Thomas},
  issn         = {0167-5273},
  language     = {eng},
  month        = {02},
  pages        = {215--219},
  publisher    = {Elsevier},
  series       = {International Journal of Cardiology},
  title        = {Sub-acute cardiac magnetic resonance to predict irreversible reduction in left ventricular ejection fraction after ST-segment elevation myocardial infarction : A DANAMI-3 sub-study},
  url          = {http://dx.doi.org/10.1016/j.ijcard.2019.10.034},
  doi          = {10.1016/j.ijcard.2019.10.034},
  volume       = {301},
  year         = {2020},
}