Prognosis of early pre‑discharge and late left ventricular dilatation by cardiac magnetic resonance imaging after acute myocardial infarction
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Prognosis of early pre‑discharge and late left ventricular dilatation by cardiac magnetic resonance imaging after acute myocardial infarction. / Sinn, Martin; Lund, Gunnar; Muellerleile, Kai; Bibiza-Freiwald, Eric; Saeed, Maythem; Avanesov, Maxim; Lenz, Alexander; Starekova, Jitka; Kodolitsch, Yskert; Blankenberg, Stefan; Adam, Gerhard; Tahir, Enver.
in: INT J CARDIOVAS IMAG, Jahrgang 37, Nr. 5, 05.2021, S. 1711–1720.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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T1 - Prognosis of early pre‑discharge and late left ventricular dilatation by cardiac magnetic resonance imaging after acute myocardial infarction
AU - Sinn, Martin
AU - Lund, Gunnar
AU - Muellerleile, Kai
AU - Bibiza-Freiwald, Eric
AU - Saeed, Maythem
AU - Avanesov, Maxim
AU - Lenz, Alexander
AU - Starekova, Jitka
AU - Kodolitsch, Yskert
AU - Blankenberg, Stefan
AU - Adam, Gerhard
AU - Tahir, Enver
PY - 2021/5
Y1 - 2021/5
N2 - To study the long-term prognosis of early pre-discharge and late left ventricular (LV) dilatation in patients with first ST-elevation myocardial infarction (STEMI) treated by percutaneous coronary intervention (PCI) and contemporary medical therapy. Long-term follow-up > 15 years was available in 53 consecutive patients (55 ± 13 years) with first STEMI. Late gadolinium enhanced (LGE) cardiac magnetic resonance imaging (CMR) was obtained at baseline 5 ± 3 days and follow-up 8 ± 3 months after STEMI to measure LV function, volumes and infarct size. Early pre-discharge dilatation was defined as increased left ventricular end-diastolic volume index (LVEDVi) at baseline CMR with > 97 ml/m2 for males and > 90 ml/m2 for females. Late dilatation was defined as initially normal LVEDVi, which increased ≥ 20% at follow-up. Early dilatation was present in 7 patients (13%), whereas late dilatation occurred in 11 patients (21%). Patients with early LV dilatation had highest mortality (57%), whereas patients with late dilatation had similar mortality (27%) compared to patients without dilatation (26%). Multivariate Cox analysis showed that age (P < 0.001), ejection fraction at baseline (P < 0.01) and early dilatation (P < 0.01) were independent predictors of death. Early dilatation qualified as an exclusive independent predictor of long-term mortality after adjustment for age and ejection fraction (P < 0.05, hazard ratio: 2.2, 95% confidence interval: 1.2 to 7.9). Early pre-discharge LV dilatation by CMR enabled strong long-term risk stratification after STEMI. The high mortality of early LV dilatation underscores the clinical importance of this post-infarction complication, which occurred despite PCI and contemporary medical therapy.
AB - To study the long-term prognosis of early pre-discharge and late left ventricular (LV) dilatation in patients with first ST-elevation myocardial infarction (STEMI) treated by percutaneous coronary intervention (PCI) and contemporary medical therapy. Long-term follow-up > 15 years was available in 53 consecutive patients (55 ± 13 years) with first STEMI. Late gadolinium enhanced (LGE) cardiac magnetic resonance imaging (CMR) was obtained at baseline 5 ± 3 days and follow-up 8 ± 3 months after STEMI to measure LV function, volumes and infarct size. Early pre-discharge dilatation was defined as increased left ventricular end-diastolic volume index (LVEDVi) at baseline CMR with > 97 ml/m2 for males and > 90 ml/m2 for females. Late dilatation was defined as initially normal LVEDVi, which increased ≥ 20% at follow-up. Early dilatation was present in 7 patients (13%), whereas late dilatation occurred in 11 patients (21%). Patients with early LV dilatation had highest mortality (57%), whereas patients with late dilatation had similar mortality (27%) compared to patients without dilatation (26%). Multivariate Cox analysis showed that age (P < 0.001), ejection fraction at baseline (P < 0.01) and early dilatation (P < 0.01) were independent predictors of death. Early dilatation qualified as an exclusive independent predictor of long-term mortality after adjustment for age and ejection fraction (P < 0.05, hazard ratio: 2.2, 95% confidence interval: 1.2 to 7.9). Early pre-discharge LV dilatation by CMR enabled strong long-term risk stratification after STEMI. The high mortality of early LV dilatation underscores the clinical importance of this post-infarction complication, which occurred despite PCI and contemporary medical therapy.
U2 - 10.1007/s10554-020-02136-5
DO - 10.1007/s10554-020-02136-5
M3 - SCORING: Journal article
VL - 37
SP - 1711
EP - 1720
JO - INT J CARDIOVAS IMAG
JF - INT J CARDIOVAS IMAG
SN - 1569-5794
IS - 5
ER -