Author + information
- Gianluca Pontone,
- Daniele Andreini,
- Giovanni Ferro,
- Andrea Igoren Guaricci,
- Marco Guglielmo,
- Saima Mushtaq,
- Andrea Baggiano,
- Patrizia Carità,
- Mauro Pepi and
- Gianluca Pontone
Background: We sought to evaluate the additional value of a multiparametric cardiac magnetic resonance (CMR) score in comparison with traditional TIMI (Thromolysis in Myocardial Infarction) score and transthoracic echocardiography (TTE) score in prognostic stratification of STEMI patients.
Methods: 209 STEMI patients reperfused by primary PCI underwent TTE and CMR 3 days after the index event. We measured: TIMI score, left ventricle ejection fraction (EFTTE), left ventricle end systolic volume (LVESVTTE) and number of myocardial segment with wall motion abnormalities (WMITTE) measured by TTE, left ventricle ejection fraction (EFCMR), left ventricle end systolic volume (LVESVCMR) and number of myocardial segment with wall motion abnormalities (WMICMR) measured by CMR, myocardial salvage index (MSI) and presence of microvascular obstruction (MVO). The primary clinical endpoint of study was the occurrence of major adverse cardiac events(MACE) defined as combined endpoint of hospitalization, acute coronary syndrome, implantable defibrillator and cardiac death.
Results: The mean follow-up was 931±495 days. Patients experiencing MACE showed higher TIMI score (p<0.05), LVESVTTE (p<0.01), WMITTE (p<0.01), LVESVCMR (p<0.01), WMICMR (p<0.01), prevalence of MVO (p<0.01) and lower EFTTE (p<0.01), EFCMR (p<0.01) and MSI (p<0.01) as compared to patients without MACE. According to the distribution of each variables, two different models based on a binary score were created: a) Model 1 based on clinical parameters and TTE: TIMI <3=0 or >3=1; LVESVTTE < 25ml/m2=0 or > 25ml/m2=1; EFTTE>50%=0 or <50%=1; WMITTE<7=0 or >7=1; b) Model 2 based on CMR: LVESVCMR<55ml/m2=0 or >50ml/m2=1; EFCMR<50%=0 or <50%=1; WMICMR<7=0 or >7=1; MSI>0.47 = 0 or <0.47=1; MVO: absence=0 or presence=1. Clustering the study population for both model with a score threshold of 2, model 2 provide a better prognostic stratification as compared to model 1 with a significant incremental prognostic value on the top of traditional outcome model (p:0.0001)
Conclusions: A multiparametric approach with CMR including markers of myocardial damage provide incremental prognostic information in addition to traditional risk scores.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Non Invasive Imaging: MR Heart Failure and Pulmonary Hypertension
Abstract Category: 29. Non Invasive Imaging: MR
Presentation Number: 1158-206
- 2017 American College of Cardiology Foundation