Guido Ligabue MD, Presenter: Nothing to Disclose

Fiocchi Federica MD, Abstract Co-Author: Nothing to Disclose

Sonia Ferraresi MD, Abstract Co-Author: Nothing to Disclose

Barbieri Andrea MD, Abstract Co-Author: Nothing to Disclose

Renato Romagnoli, Abstract Co-Author: Nothing to Disclose

Pietro Torricelli MD, Abstract Co-Author: Nothing to Disclose

To assess the accuracy of MRI to predict left ventricular (LV) remodelling after Primary coronary angioplasty (PCI).

Sixty-one patients with previous myocardial infarction (MI) (37 anterior MIs) underwent cine and contrast enhanced MRI at baseline (14±3 days) and at 6 months post-PCI. Remodelling was defined as >20% increase in end-diastolic volume (EDV) at 6 months in relation to baseline. Enhanced myocardium was quantified and expressed as percentage correlated to myocardial mass (DE%). Using a segmental model, each segment was assigned a infarct extension score ranging from 0=no enhancement to 4= enhancement > 75%; thus each patient was given a infarct transmural extension index (TEI= S scores [(0-4) X 17]/ (17 X 4).

Four patients were excluded for the occurrence of major cardiac events during follow-up. Even if at baseline MRI, EDV and ejection fraction (EF) did not significantly differ in patients with (n=8) and without remodelling (151±31 VS 151.5±59ml and 47.1±14.7 VS 51.7±20% respectively), in the first group TEI (0.33±0.11 VS 0.2±0.15, p=0.002) and DE% were higher(23.3±12 VS 16.2±12.2%, p=0.003). At follow up MRI, EDV increased further and significantly (191.6±32.5ml)and EF (40.5±12.5%) decreased in patients with remodelling, whilst EDV slightly decrease and EF slightly increased in patients without remodelling (148.4±44.5ml and 54.2±13.6% respectively). Moreover shrinkage of enhanced myocardium was greater in the non remodelling group (16.5±5 VS 3.5±4%, p=0.001). If we choose TEI=0.27 as cut off value to discriminate patient with LV adverse remodelling sensitivity, specificity, and positive and negative predictive value are 88.9%, 77.1%, 42.1% and 97.4%, respectively.

Baseline MRI is sensitive in detecting subsequent negative LV remodelling; furthermore TEI can be considered a relevant negative predictive tool to exclude adverse remodelling.

The possibility to have a non invasive tool to predict adverse remodelling depending on infarct size and distribution regarding each specific patient.

Ligabue, G, Federica, F, Ferraresi, S, Andrea, B, Romagnoli, R, Torricelli, P, How to Objectively Evaluate Contrast-enhanced MRI to Predict Adverse Left Ventricle Remodelling: A Follow-up Study in a Population Submitted to Primary Coronary Angioplasty.  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/4435623.html