Performance of angiographic, electrocardiographic and MRI methods to assess the area at risk in acute myocardial infarction. Issue 2 (19th September 2011)

• Record Type: Journal Article
• Authors: Versteylen, Mathijs O; Bekkers, Sebastiaan C A M; Smulders, Martijn W; Winkens, Bjorn; Mihl, Casper; Winkens, Mark H M; Leiner, Tim; Waltenberger, Johannes L; Kim, Raymond J; Gorgels, Anton P M
• Is Part Of: Heart. Volume 98:Issue 2(2012)
• Page Start: 109
• Page End: 115
• Publication Date: 2011-09-19
• Subjects: Myocardial infarction -- angiography -- electrocardiography -- MRI -- diagnosis -- oedema -- coronary artery disease -- CT scanning -- cardiac remodelling -- echocardiography -- transoesophageal -- transthoracic -- MRI -- cardiac function -- imaging and diagnostics -- EBM -- STEMI -- stable angina -- NSTEMI -- 12 lead ECG -- myocardial viability; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2011-300185
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Objective: Validation of methods to assess the area at risk (AAR) in patients with ST elevation myocardial infarction is limited. A study was undertaken to test different AAR methods using established physiological concepts to provide a reference standard. Main outcome measured: In 78 reperfused patients with first ST elevation myocardial infarction, AAR was measured by electrocardiographic (Aldrich), angiographic (Bypass Angioplasty Revascularization Investigation (BARI), APPROACH) and cardiovascular magnetic resonance methods (T2-weighted hyperintensity and delayed enhanced endocardial surface area (ESA)). The following established physiological concepts were used to evaluate the AAR methods: (1) AAR size is always ≥ infarct size (IS); (2) in transmural infarcts AAR size=IS; (3) correlation between AAR size and IS increases as infarct transmurality increases; and (4) myocardial salvage ((AAR-IS)/AAR×100) is inversely related to infarct transmurality. Results: Overall, 65%, 87%, 76%, 87% and 97% of patients using the Aldrich, BARI, APPROACH, T2-weighted hyperintensity and ESA methods obeyed the concept that AAR size is ≥IS. In patients with transmural infarcts (n=22), Bland–Altman analysis showed poor agreement (wide 95% limits of agreement) between AAR size and IS for the BARI, Aldrich and APPROACH methods (95% CI −22.9 to 29.6, 95% CI −28.3 to 21.3 and 95% CI −16.9 to 20.0, respectively) and better agreement for T2-weighted hyperintensity and ESA (95% CI −6.9 to 16.6 and 95% CI −4.3 to 18.0, respectively). Increasing correlation between AAR size and IS with increasing infarct transmurality was observed for the APPROACH, T2-weighted hyperintensity and ESA methods, with ESA having the highest correlation (r=0.93, p<0.001). The percentage of patients within a narrow margin (±30%) of the inverse line of identity between salvage extent and infarct transmurality was 56%, 76%, 65%, 77% and 92% for the Aldrich, BARI, APPROACH, T2-weighted hyperintensity and ESA methods, respectively, where higher percentages represent better concordance with the concept that the extent of salvage should be inversely related to infarct transmurality. Conclusions: For measuring AAR, cardiovascular magnetic resonance methods are better than angiographic methods, which are better than electrocardiographic methods. Overall, ESA performed best for measuring AAR in vivo.