Cardiac computed tomography for prediction of myocardial viability after reperfused acute myocardial infarction

Shapiro, Michael D.; Sarwar, Ammar; Nieman, Koen; Nasir, Khurram; Brady, Thomas J.; Cury, Ricardo C.

doi:10.1016/j.jcct.2010.04.004

« Previous Next »Journal of Cardiovascular Computed Tomography
Volume 4, Issue 4 , Pages 267-273, July 2010

Cardiac computed tomography for prediction of myocardial viability after reperfused acute myocardial infarction

Michael D. Shapiro, DO
- Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Cardiovascular Medicine, Oregon Health and Science University, Portland, OR, USA
Ammar Sarwar, MD
- Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
Koen Nieman, MD
- Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
Khurram Nasir, MD, MPH
- Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
Thomas J. Brady, MD
- Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
Ricardo C. Cury, MD
- Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Cardiovascular MR and CT Program, Baptist Cardiac and Vascular Institute, 8900 N Kendall Drive, Miami, FL 33176, USA
- Corresponding author.

Received 6 December 2009; accepted 6 April 2010. published online 21 April 2010.

Background

Perfusion defects (PDs) detected with cardiac magnetic resonance (CMR) imaging predict the functional recovery of myocardial function after acute myocardial infarction.

Objective

We evaluated the ability of cardiac computed tomography (CCT) to predict the recovery of regional left ventricular (LV) systolic function after ST elevation myocardial infarction (STEMI).

Methods

Seventeen patients (mean age, 60 ± 10 years) presenting with STEMI were prospectively studied. Each patient underwent CCT and CMR at baseline and after an average of 6 months. Areas of PD were quantified. Segmental LV systolic function was semiquantitatively assessed by CMR. An improvement at 6 months by ≥1 category in the regional wall motion score was considered LV recovery.

Results

Coronary artery revascularization was successfully performed with postprocedural TIMI 3 flow in 16 cases. On CCT assessment, 107 of 289 segments (37%) had some degree of PD. On follow-up, segments with <25% PD at baseline had no worsening of wall motion. In segments with >75% PD, 89% (9 of 11) showed akinesis or worsening of wall motion. The odds ratio for improvement in segmental wall motion with increasing PD category was 0.63 (95% CI, 0.42–0.97; P = 0.035). The degree of PD on CT predicted LV recovery at follow-up (P < 0.0001).

Conclusions

The transmural extent of myocardial infarction as detected and quantified with CCT predicts the recovery of regional systolic LV function after revascularization for acute STEMI.

Keywords: Magnetic resonance imaging, Multidetector computed tomography, Myocardial infarction, Revascularization, Viability