Assessment of viability of a myocardium by MDCT for prediction of left ventricular remodeling after myocardial infarction.

Congress:

ECR 2013

Poster Number:

C-1569

Type:

Scientific Exhibit

Keywords:

Acute, Contrast agent-intravenous, MR, Echocardiography, CT, Emergency, Contrast agents, Cardiac

Authors:

S. K. Ternovoy, T. N. Veselova, I. Merculova, M. Y. Ruda; Moscow/RU

DOI:

10.1594/ecr2013/C-1569

DOI-Link:

https://dx.doi.org/10.1594/ecr2013/C-1569

Fig. 1: Subendocardial (arrow) RD in a patient with right coronary artery territory...

Fig. 2: Tramsmural RD (arrow) with subendocardial DHE (arrowhead) of myocardium in the...

Fig. 3: Transmural (arrow) extension of myocardium DE in the left circumflex artery...

Table 1: Infarct size, number of nonviable LV segments and left ventricular functional...

Purpose

Aim of the study was to assess perfusion defect and viability of the myocardium by the method of multispiral computed tomography (MSCT) in patients with ST-elevation acute myocardial infarction (STEMI) and to assess prognostic role of myocardial contrast delayed enhancementin development of remodeling of the left ventricle (LV).

Methods and Materials

In study were included 117 patients with first AMI (111 male, 6 female, age55,4±10,1 years). Two-phase contrast-enhanced ECG-gated MDCT was performed using a 64-slice MDCT scanner (Aquilion 64; Toshiba Medical Systems Corporation, Otawara, Japan), which is a 640.5 mm collimation scanner with a gantry rotation speed of 400 ms/rotation. Scanning was performed at 120 kV and 400 mAs, and the table feed was 6.4 mm/gantry rotation with a beam pitch of 0.2 The acquisition protocol included both early (arterial) and delay phases acquisition. In arterial...

Results

In patients with signs of viable myocardium (group 1) volume of perfusion defectwas substantially smaller than in patients with nonviable myocardium (groups 2 and 3): 1 cm3 (0.4—2.4) vs. 7.3 cm3 (5.3—10.0) and 6.3 cm3(5.0—15.0), respectively, p<0.001 (table 1). LVESV and LVEDV were significantlyhigher and the EF is lower In the Group 1than in the otherGroups (table 1). Patients of Group 1 more often were female (p=0.04), had inferior MI (p<0.001), and spontaneous reperfusion (p<0.001) compared with Groups 2 and 3. During the 12-month period...

Conclusion

Myocardial contrast-delayed enhancement patterns provide promising information for regarding myocardial viability, LV remodelling, and prognosis in patients with AMI.

References

1. Habis M, Capderou A, Ghostine S,et al. Acute myocardial infarction early viability assessment by 64-slicecomputed tomography immediately after coronary angiography: comparisonwith low-dose dobutamine echocardiography. J Am Coll Cardiol2007;49:1178 – 85. 2.Veselova TN,Shitov VN,Vlodzianovskiĭ VV,Merkulova IN,Iarovaia EB,Ternovoy SK,Ruda M.Ya. Comparison of multislice spiral computed tomography and stress echocardiography in the evaluation of myocardial viability in patients with acute myocardial infarction. Vestn Rentgenol Radiol.2011;4: 24-30. 3. Sato A, Hiroe M, Nozato T, et al. Early validation study of 64-slice multidetector computed tomography for the assessment of...