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Prediction of Left Ventricular Remodeling and Analysis of Infarct Resorption in Patients with Reperfused Myocardial Infarcts by Using Contrast-enhanced MR Imaging¹

¹ From the Departments of Cardiology (G.K.L., K.M., A.A.B., M.K., U.S., M.M., T.M.) and Diagnostic and Interventional Radiology (A.S., M.P.B., G.A.), University Hospital Eppendorf, Hamburg, Germany; Coordination Center for Clinical Trials, University of Düsseldorf, Düsseldorf, Germany (P.E.V.); and Department of Radiology, University of California–San Francisco, San Francisco, Calif (M.S.). Received July 14, 2006; revision requested September 18; revision received November 21; accepted January 8, 2007; final version accepted February 12. Address correspondence to G.K.L., Roentgeninstitut, Kaiserswerther Str 89, 40476 Düsseldorf, Germany (e-mail: lund{at}roentgeninstitut.de).

Purpose: To prospectively evaluate the accuracy of clinical and cardiac magnetic resonance (MR) imaging parameters for predicting left ventricular (LV) remodeling by using follow-up imaging as reference standard, and to prospectively evaluate infarct resorption in patients with reperfused first myocardial infarcts.

Materials and Methods: The study was approved by the institutional ethics committee and all patients gave written informed consent. In 55 patients (48 men, seven women; mean age ± standard deviation, 56 years ± 13), contrast material–enhanced and cine MR imaging were performed 5 days ± 3 and 8 months ± 3 after myocardial infarction (MI). Microvascular obstruction (MO) and infarct size were estimated at first-pass enhancement (FPE) and delayed enhancement (DE) MR, respectively. Remodeling was defined as an increase in LV end-diastolic volume index of 20% or higher at follow-up. Differences in continuous and categorical data were analyzed by using Student t test and Fischer exact test as appropriate.

Results: Patients with remodeling (n = 13, 24%) had higher creatine kinase MB (P < .05), more anterior infarcts (P < .05), more often a reduced Thrombolysis in Myocardial Infarction flow (P < .05), larger infarct size at DE MR (P < .001), a greater extent of MO at FPE MR (P < .01), lower ejection fraction (P < .001) and higher LV end-systolic volume index (P < .01). Infarct size at DE MR was a powerful predictor for remodeling (odds ratio: 1.18, P < .001), demonstrating that the risk for remodeling increased 2.8-fold with each 10% increase in infarct size. Infarct size of 24% or more of LV area predicted remodeling with high sensitivity (92%), specificity (93%), and accuracy (93%). Infarct resorption was larger in patients with remodeling (P < .01).

Conclusion: Infarct size 24% or more of the LV area constitutes an important threshold to predict remodeling. Patients with remodeling develop disproportionate infarct resorption.

© RSNA, 2007