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  • Title: Usefulness of a comprehensive cardiovascular magnetic resonance imaging assessment for predicting recovery of left ventricular wall motion in the setting of myocardial stunning.
    Author: Bodí V, Sanchis J, López-Lereu MP, Losada A, Núñez J, Pellicer M, Bertomeu V, Chorro FJ, Llácer A.
    Journal: J Am Coll Cardiol; 2005 Nov 01; 46(9):1747-52. PubMed ID: 16256880.
    Abstract:
    OBJECTIVES: We sought to evaluate the usefulness of a comprehensive assessment of four cardiovascular magnetic resonance imaging (CMR)-derived myocardial viability indexes in the setting of myocardial stunning. BACKGROUND: Cardiovascular magnetic resonance imaging allows the simultaneous assessment of several viability indexes. METHODS: We studied 40 patients with a first ST-segment elevation myocardial infarction (MI) and an open infarct-related artery. At the first week, using CMR, wall motion (WM), and four viability indexes were determined: wall thickness, WM improvement with low-dose dobutamine, perfusion, and transmural extent of necrosis. We created a comprehensive score based on the presence and the relative power of these viability indexes for predicting normal WM at the sixth month. RESULTS: Of 153 dysfunctional segments at the first week, 59 (39%) exhibited normal WM at the sixth month. According to the odds ratio of viability indexes for predicting normal WM, we developed a five-level predictive score. The proportions of segments showing normal WM at sixth month were as follows; Level 1 (0 indexes): 0 of 13 (0%); Level 2 (normal thickness and/or perfusion): 14 of 82 (17%); Level 3 (dobutamine response): 5 of 11 (45%); Level 4 (non-transmural necrosis): 20 of 26 (77%); Level 5 (non-transmural necrosis and dobutamine response): 20 of 21 (95%), p < 0.0001 for the trend. These proportions were similar in a matched prospective validation group comprising 16 patients (0%, 18%, 62%, 77%, and 90% for levels 1 to 5, respectively, p < 0.0001 for the trend). CONCLUSIONS: A comprehensive analysis of the four more widely used CMR-derived viability indexes is useful for predicting late systolic function after myocardial infarction.
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