Portal de investigación
Ejection Fraction by Echocardiography for a Selective Use of Magnetic Resonance After Infarction.
Fecha de publicación:
Fecha Ahead of Print:
Autores de INCLIVA
Participantes ajenos a INCLIVA
- Lopez-Lereu, Maria P
- Valente, Filipa
- Lorenzatti, Daniel
- Rodriguez-Palomares, Jose F
- Ortiz-Perez, Jose T
Grupos y Plataformas de I+D+i
Abstract
Background Cardiac magnetic resonance (CMR) permits robust risk stratification of discharged ST-segment-elevation myocardial infarction patients, but its indiscriminate use in all cases is not feasible. We evaluated the utility of left ventricular ejection fraction (LVEF) by echocardiography for a selective use of CMR after ST-segment-elevation myocardial infarction. Methods Echocardiography and CMR were performed in 1119 patients discharged for ST-segment-elevation myocardial infarction included in a multicenter registry. The prognostic power of CMR beyond echocardiography-LVEF was assessed using adjusted C statistic, net reclassification improvement index, and integrated discrimination improvement index. Results During a 4.8-year median follow-up, 136 (12%) first major adverse cardiac events (MACE) occurred (47 cardiovascular deaths and 89 readmissions for acute heart failure). In the entire group, CMR-LVEF (but not echocardiography-LVEF) independently predicted MACE occurrence. The MACE rate significantly increased only in patients with CMR-LVEF<40% (=50%: 7%, 40%-49%: 9%, <40%: 27%, P<0.001). Most patients displayed echocardiography-LVEF=50% (629, 56%), and they had a low MACE rate (57/629, 9%). In patients with echocardiography-LVEF<50% (n=490, 44%), the MACE rate was also low in those with CMR-LVEF=40% (24/278, 9%) but significantly increased in patients with CMR-LVEF<40% (55/212, 26%; P<0.001). Compared with echocardiography-LVEF, CMR-LVEF significantly improved MACE prediction in the group of patients with echocardiography-LVEF<50% (C statistic, 0.80 versus 0.72; net reclassification improvement index, 0.73; integrated discrimination improvement index, 0.10) but not in those with echocardiography-LVEF=50% (C statistic 0.66 versus 0.66; net reclassification improvement index, 0.17; integrated discrimination improvement index, 0.01). Conclusions A straightforward strategy based on a selective use of CMR for risk prediction in ST-segment-elevation myocardial infarction patients with echocardiography-LVEF<50% can provide insights into patient care. The cost-effectiveness of this approach, as well as the direct implications in clinical management, should be further explored.
© 2020 American Heart Association, Inc
Datos de la publicación
- ISSN/ISSNe:
- 1941-9651, 1942-0080
- Tipo:
- Article
- Páginas:
- 11491-11491
- PubMed:
- 33297764
CIRCULATION-CARDIOVASCULAR IMAGING LIPPINCOTT WILLIAMS & WILKINS
Citas Recibidas en Web of Science: 19
Documentos
Filiaciones
Keywords
- echocardiography; heart failure; myocardial infarction; magnetic resonance; prognosis; risk; ventricular ejection fraction
Financiación
Proyectos y Estudios Clínicos
Resolution of microvascular obstruction after myocardial infarction. A multidisciplinary approach to assess the structural and clinical consequences and to evaluate new therapeutic options.
Investigador Principal: VICENT BODÍ PERIS
PI20/00637 . INSTITUTO SALUD CARLOS III . 2021
Cita
Ejection Fraction by Echocardiography for a Selective Use of Magnetic Resonance After Infarction. Marcos V, Gavara J, Lopez MP, Monmeneu JV, Rios C, de Dios E, Perez N et al. CIRCULATION-CARDIOVASCULAR IMAGING. 2020 diciembre 01. 13 (12):11491-11491. DOI:10.1161/CIRCIMAGING.120.011491. PMID:33297764.
