Predictors of segmental myocardial functional recovery in patients after an acute ST-elevation myocardial infarction

Mangion, K. et al. (2019) Predictors of segmental myocardial functional recovery in patients after an acute ST-elevation myocardial infarction. European Journal of Radiology, 112, pp. 121-129. (doi: 10.1016/j.ejrad.2019.01.010) (PMID:30777200) (PMCID:PMC6390173)

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Objective: We hypothesized that Displacement Encoding with Stimulated Echoes (DENSE) and feature-tracking derived circumferential strain would provide incremental prognostic value over the extent of infarction for recovery of segmental myocardial function. Methods: Two hundred and sixty-one patients (mean age 59 years, 73% male) underwent MRI 2 days post-ST elevation myocardial infarction (STEMI) and 241 (92%) underwent repeat imaging 6 months later. The MRI protocol included cine, 2D-cine DENSE, T2 mapping and late enhancement. Wall motion scoring was assessed by 2-blinded observers and adjudicated by a third. (WMS: 1=normal, 2=hypokinetic, 3=akinetic, 4=dyskinetic). WMS improvement was defined as a decrease in WMS ≥ 1, and normalization where WMS = 1 on follow-up. Segmental circumferential strain was derived utilizing DENSE and feature-tracking. A generalized linear mixed model with random effect of subject was constructed and used to account for repeated sampling when investigating predictors of segmental myocardial improvement or normalization Results: At baseline and follow-up, 1416 segments had evaluable data for all parameters. Circumferential strain by DENSE (p < 0.001) and feature-tracking (p < 0.001), extent of oedema (p < 0.001), infarct size (p < 0.001), and microvascular obstruction (p < 0.001) were associates of both improvement and normalization of WMS. Circumferential strain provided incremental predictive value even after accounting for infarct size, extent of oedema and microvascular obstruction, for segmental improvement (DENSE: odds ratio, 95% confidence intervals: 1.08 per −1% peak strain, 1.05–1.12, p < 0.001, feature-tracking: odds ratio, 95% confidence intervals: 1.05 per −1% peak strain, 1.03–1.07, p < 0.001) and segmental normalization (DENSE: 1.08 per −1% peak strain, 1.04–1.12, p < 0.001, feature-tracking: 1.06 per −1% peak strain, 1.04–1.08, p < 0.001). Conclusions: Circumferential strain provides incremental prognostic value over segmental infarct size in patients post STEMI for predicting segmental improvement or normalization by wall-motion scoring.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Mccomb, Dr Christie and Carrick, Dr David and Clerfond, Dr Guillaume and Mangion, Dr Kenneth and Hood, Dr Stuart and Eteiba, Professor Hany and Petrie, Professor Mark and Oldroyd, Dr Keith and Rush, Dr Christopher and Berry, Professor Colin and Haig, Dr Caroline
Authors: Mangion, K., Carrick, D., Clerfond, G., Rush, C., McComb, C., Oldroyd, K. G., Petrie, M. C., Eteiba, H., Lindsay, M., McEntegart, M., Hood, S., Watkins, S., Davie, A., Auger, D. A., Zhong, X., Epstein, F. H., Haig, C. E., and Berry, C.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:European Journal of Radiology
ISSN (Online):1872-7727
Published Online:14 January 2019
Copyright Holders:Copyright © 2019 The Authors
First Published:First published in European Journal of Radiology 112:121-129
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
662681"First steps towards modelling myocardial infarction (a computed MI Physiome): A case-control study of novel biomechanical parameters in acute MI survivors with left ventricular dysfunction."Colin BerryBritish Heart Foundation (BHF)PG/14/64/31043RI CARDIOVASCULAR & MEDICAL SCIENCES
699321Myocardial strain measurements in survivors of acute ST-elevation myocardial infarction: implementation and prognostic significance of novel magnetic resonance imaging methods.Colin BerryBritish Heart Foundation (BHF)FS/15/54/31639RI CARDIOVASCULAR & MEDICAL SCIENCES