Author + information
- Abhishek Sharma, MD⁎ ( and )
- Saurav Chatterjee, MD
- ↵⁎Maimonides Medical Center, 1016 50th Street, Apartment 2C, Brooklyn, New York 11219
We read with great interest the article by Sato et al. (1) that evaluated the prognostic value of myocardial contrast delayed enhancement with 64-slice multidetector computed tomography (MDCT) after acute myocardial infarction. They should be commended for conducting the study elegantly. However, a few interesting points arise from the analysis that we believe may be pertinent and should be answered.
Because MDCT can detect peri-infarct tissue heterogeneity that can trigger ventricular arrhythmias (2), which are a common cause of morbidity and mortality in patients who have had a myocardial infarction. Did the authors make an attempt to evaluate and correlate peri-infarct heterogeneity with prognosis? Also, automated implantable cardioverter-defibrillators (AICDs) are known to improve the prognosis in a subset of patients who have had a myocardial infarction (3), so it would be interesting to know the AICD distribution among various tertiles and among event groups and whether the authors adjusted its distribution as a possible confounding factor.
Were patients with high levels of biomarkers that are known to be associated with poor prognosis and are highly correlated with delayed enhancement size (creatine kinase-myocardial band, troponin, poor left ventricular ejection fraction) treated more aggressively, or was any attempt made to standardize the therapy after hospital discharge?
Because the number of segments with transmural infarct (on the 17-segment model) is a strong and independent predictor of prognosis (4), it would be interesting to know if authors made an attempt to determine which is the better prognostic indicator: the number of segments involved or infarct size (e.g., multiple segments with subendocardial infarct versus few segments with transmural infarct).
Did the authors make any attempt to study the significance of calcium deposits in acute infarct detected on MDCT and its impact on prognosis?
MDCT is an excellent alternative in situations where magnetic resonance imaging (MRI) is contraindicated and attributing to its improving resolution and reduced partial volume effect that results in a more accurate assessment of area amenable to revascularization, which might replace MRI in the future. However, the absence of a universally acceptable protocol for delayed imaging is a critical road block due to the time dependent nature of the contrast uptake. Another limitation is hyperenhancement of both acute and chronic infarct, which limit the role of delayed enhancement on multidetector computed tomography in patients with a history of myocardial infarction.
- American College of Cardiology Foundation
- Sato A.,
- Nozato T.,
- Hikita H.,
- et al.
- Schuleri K.H.,
- Centola M.,
- George R.T.,
- et al.
- Gregoratos G.,
- Cheitlin M.D.,
- Conill A.,
- et al.