Scar extent, left ventricular end-diastolic volume, and wall motion abnormalities identify high-risk patients with previous myocardial infarction: a multiparametric approach for prognostic stratification
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Gianluca Di Bella1, Valeria Siciliano, Giovanni Donato Aquaro
1CNR, Institute of Clinical Physiology, G. Monasterio Foundation, Via Moruzzi, 1, 56124, Pisa, Italy.
Insights
Combining cardiac magnetic resonance imaging (CMR) metrics like scar extent, left ventricular (LV) volumes, and wall motion abnormalities significantly enhances risk stratification for patients post-myocardial infarction (MI). This multiparametric approach offers improved prediction of cardiac events.
Area of Science:
- Cardiology
- Medical Imaging
- Biomedical Engineering
Background:
- Patients with previous myocardial infarction (MI) are at risk for adverse cardiac events.
- Accurate risk stratification is crucial for guiding patient management and therapeutic decisions.
- Current risk assessment models may not fully capture the complex pathophysiology post-MI.
Purpose of the Study:
- To evaluate if combining left ventricular (LV) volumes, regional wall motion abnormalities, and scar tissue extent from cardiac magnetic resonance (CMR) improves risk stratification in patients with prior MI.
- To determine the independent prognostic value of these CMR-derived parameters.
Main Methods:
- A cohort of 231 patients with previous MI underwent cine CMR and late gadolinium enhancement (LGE) imaging.
- LV volumes, regional wall motion abnormalities (wall motion score index), and scar extent (LGE percentage) were quantified.
- Patients were followed for a median of 3.2 years for cardiac events (cardiac death or appropriate ICD shocks).
Main Results:
- An LGE extent >12.7%, LV end-diastolic volume >105 mL/m², and a wall motion score index >1.7 were independently associated with adverse cardiac events.
- Patients with none of these factors had a significantly lower risk (HR=0.112) compared to those with all three.
- The cumulative 4-year event rate was 3.5% for patients with no factors, 7.7% for one or two factors, and 29.6% for all three factors.
Conclusions:
- A multiparametric CMR approach integrating scar extent, LV volumes, and regional wall motion abnormalities significantly enhances risk stratification in patients post-MI.
- This comprehensive imaging strategy provides more accurate prediction of future cardiac events than individual parameters alone.
- This method can aid clinicians in identifying high-risk individuals needing closer monitoring or intervention.
Aims:
We sought to investigate whether combining left ventricular (LV) volumes, regional wall motion abnormalities, and scar tissue extent obtained by cardiac magnetic resonance (CMR) improves risk stratification of patients with previous myocardial infarction (MI).
Methods And Results:
In 231 consecutive patients (age 64 ± 11 years, males 89%) with previous MI, we quantified LV volumes and regional wall motion abnormalities by cine CMR, and measured the extent of the infarction scar by late gadolinium enhancement (LGE). During follow-up (median, 3.2 years) cardiac events (cardiac death or appropriate intra-cardiac defibrillator shocks) occurred in 19 patients. After adjustment for age, an extent of LGE >12.7%, an LV end-diastolic volume >105 mL/m(2), and a wall motion score index >1.7 were independent associated with adverse cardiac events at multivariate analysis (P < 0.05, P < 0.001, and P < 0.01, respectively). The patients with none of these factors, and those with one or two factors, showed a lower risk of cardiac events [hazard ratio (HR) = 0.112, P < 0.01 and HR = 0.261, P < 0.05] than those with three factors. The cumulative event-rate estimated at 4 years was 29.6% in patients with all three factors, 7.7% in those with one or two factors, and 3.5% in patients with none of these factors.
Conclusion:
A multiparametric CMR approach, which includes the measure of scar tissue extent, LV end-diastolic volume and regional wall motion abnormalities, improves risk stratification of patients with previous MI.
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