Sub-acute cardiac magnetic resonance to predict irreversible reduction in left ventricular ejection fraction after ST-segment elevation myocardial infarction: A DANAMI-3 sub-study

Research output: Contribution to journalArticle

Abstract

Aims: To predict irreversible reduction in left ventricular ejection fraction (LVEF) during admission for ST-segment elevation myocardial infarction (STEMI) using cardiac magnetic resonance (CMR) in addition to classical clinical parameters. Irreversible reduction in LVEF is an important prognostic factor after STEMI which necessitates medical therapy and implantation of prophylactic implantable cardioverter defibrillator (ICD). Methods and results: A post-hoc analysis of DANAMI-3 trial program (Third DANish Study of Optimal Acute Treatment of Patients With ST-elevation Myocardial Infarction) which recruited 649 patients who had CMR performed during index hospitalization and after 3 months. Patients were divided into two groups according to CMR-LVEF at 3 months: Group 1 with LVEF≤35% and Group 2 with LVEF>35%. Group 1 included 15 patients (2.3%) while Group 2 included 634 patients (97.7%). A multivariate analysis showed that: Killip class >1 (OR 7.39; CI:1.47–36.21, P = 0.01), symptom onset-to-wire ≥6 h (OR 7.19; CI 1.07–50.91, P = 0.04), LVEF≤35% using index echocardiography (OR 7.11; CI: 1.27–47.43, P = 0.03), and infarct size ≥40% of LV on index CMR (OR 42.62; CI:7.83–328.29, P < 0.001) independently correlated with a final LVEF≤35%. Clinical models consisted of these parameters could identify 7 out of 15 patients in Group 1 with 100% positive predictive value. Conclusion: Together with other clinical measurements, the assessment of infarct size using late Gadolinium enhancement by CMR during hospitalization is a strong predictor of irreversible reduction in CMR_LVEF ≤35. That could potentially, after validation with future research, aids the selection and treatment of high-risk patients after STEMI, including implantation of prophylactic ICD during index hospitalization.

Details

Authors
  • Karam Sadoon Alzuhairi
  • Jacob Lønborg
  • Kiril Aleksov Ahtarovski
  • Lars Nepper-Christensen
  • Kasper Kyhl
  • Jens F. Lassen
  • Rikke Sørensen
  • Francis Joshi
  • Adam Ali Ghotbi
  • Mikkel Schoos
  • Christoffer Goransson
  • Litten Bertelsen
  • Steffen Helqvist
  • Lene Holmvang
  • Erik Jørgensen
  • Frants Pedersen
  • Hans Henrik Tilsted
  • Dan Høfsten
  • Lars Køber
  • Henning Kelbæk
  • Niels Vejlstrup
Organisations
External organisations
  • Copenhagen University Hospital
  • Zealand University Hospital
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cardiac and Cardiovascular Systems
  • Radiology, Nuclear Medicine and Medical Imaging

Keywords

  • Cardiac MRI, Prophylactic ICD, Reduced LVEF, STEMI
Original languageEnglish
Pages (from-to)215-219
Number of pages5
JournalInternational Journal of Cardiology
Volume301
Early online date2019 Oct 24
Publication statusPublished - 2020 Feb 15
Publication categoryResearch
Peer-reviewedYes