Risk score for early risk prediction by cardiac magnetic resonance after acute myocardial infarction

[EN] Background: Cardiac magnetic resonance (CMR) performed early after ST-segment elevation myocardial infarction (STEMI) can improve major adverse cardiac event (MACE) risk prediction. We aimed to create a simple clinical-CMR risk score for early MACE risk stratification in STEMI patients. Methods: We performed a multicenter prospective registry of reperfused STEMI patients (n = 1118) in whom early (1-week) CMR-derived left ventricular ejection fraction (LVEF), infarct size and microvascular obstruction (MVO) were quantified. MACE was defined as a combined clinical endpoint of cardiovascular (CV) death, nonfatal myocardial infarction (NF-MI) or re-admission for acute decompensated heart failure (HF). Results: During a median follow-up of 5.52 [2.63-7.44] years, 216 first MACE (58 CV deaths, 71 NF-MI and 87 HF) were registered. Mean age was 59.3 +/- 12.3 years and most patients (82.8%) were male. Based on the four variables independently associated with MACE, we computed an 8-point risk score: time to reperfusion >4.15 h (1 point), GRACE risk score > 155 (3 points), CMR-LVEF 1.5 segments (1 point). This score permitted MACE risk stratification: MACE per 100 person-years was 1.96 in the low-risk category (0-2 points), 5.44 in the intermediate-risk category (3-5 points), and 19.7 in the high-risk category (6-8 points): p 4.15 h and GRACE risk score > 155) and CMR (LVEF 1.5 segments) variables allows for simple and straightforward MACE risk stratification early after STEMI. External validation should confirm the applicability of the risk score.This work was supported by the Instituto de Salud Carlos III and cofunded by Fondo Europeo de Desarrollo Regional (FEDER) (grants PI20/00637 and CIBERCV16/11/00486), "Marató TV3" [grant number 20153030-31-32], the Catalonian Society of Cardiology 2015, La Caixa Foundation [HR17-00527], and by Sociedad Española de Cardiología (grant SEC/FECINV-CLI 21/024). D.M. acknowledges financial support from the Conselleria d'Educació, Investigació, Cultura i Esport, Generalitat Valenciana (grants AEST/ 2019/037 and AEST/2020/029). J. G. acknowledges financial support from the Agencia Estatal de Investigación (grant FJC2020-043981-I / AEI/10.13039/501100011033).Marcos-Garcés, V.; Perez, N.; Gavara-Doñate, J.; Lopez-Lereu, MP.; Monmeneu, JV.; Rios-Navarro, C.; De Dios, E.... (2022). Risk score for early risk prediction by cardiac magnetic resonance after acute myocardial infarction. International Journal of Cardiology. 349:150-154. https://doi.org/10.1016/j.ijcard.2021.11.05015015434

Cardiac magnetic resonance outperforms echocardiography to predict subsequent implantable cardioverter defibrillator therapies in ST-segment elevation myocardial infarction patients

Altres ajuts: Conselleria de Educación-Generalitat Valenciana (PROMETEO/2021/008); Sociedad Española de Cardiología (Grant SEC/FEC-INVCLI 21/024)Implantable cardioverter defibrillators (ICD) are effective as a primary prevention measure of ventricular tachyarrhythmias in patients with ST-segment elevation myocardial infarction (STEMI) and depressed left ventricular ejection fraction (LVEF). The implications of using cardiac magnetic resonance (CMR) instead of echocardiography (Echo) to assess LVEF prior to the indication of ICD in this setting are unknown. We evaluated 52 STEMI patients (56.6 ± 11 years, 88.5% male) treated with ICD in primary prevention who underwent echocardiography and CMR prior to ICD implantation. ICD implantation was indicated based on the presence of heart failure and depressed LVEF (≤ 35%) by echocardiography, CMR, or both. Prediction of ICD therapies (ICD-T) during follow-up by echocardiography and CMR before ICD implantation was assessed. Compared to echocardiography, LVEF was lower by cardiac CMR (30.2 ± 9% vs. 37.4 ± 7.6%, p < 0.001). LVEF ≤ 35% was detected in 24 patients (46.2%) by Echo and in 42 (80.7%) by CMR. During a mean follow-up of 6.1 ± 4.2 years, 10 patients received appropriate ICD-T (3.16 ICD-T per 100 person-years): 5 direct shocks to treat very fast ventricular tachycardia or ventricular fibrillation, 3 effective antitachycardia pacing (ATP) for treatment of ventricular tachycardia, and 2 ineffective ATP followed by shock to treat ventricular tachycardia. Echo-LVEF ≤ 35% correctly predicted ICD-T in 4/10 (40%) patients and CMR-LVEF ≤ 35% in 10/10 (100%) patients. CMR-LVEF improved on Echo-LVEF for predicting ICD-T (area under the curve: 0.76 vs. 0.48, p = 0.04). In STEMI patients treated with ICD, assessment of LVEF by CMR outperforms Echo-LVEF to predict the subsequent use of appropriate ICD therapies

Resonancia magnética cardiaca de estrés para predecir mortalidad y toma de decisiones: registro de 2.496 pacientes mayores con síndrome coronario crónico

[ES] Introducción y objetivos: El tratamiento del paciente mayor con síndrome coronario crónico (SCC) es un reto. Se exploró el valor pronóstico y la utilidad para la toma de decisiones de la carga isquémica determinada mediante resonancia magnética cardiaca (RMC) de estrés con vasodilatador en pacientes mayores con SCC. Métodos: Se incluyo¿ a 2.496 pacientes mayores de 70 años estudiados con una RMC de estrés con vasodilatador por SCC conocido o sospechado. La carga isquémica (número de segmentos con déficit de perfusión inducido por el estrés) se calculo¿ siguiendo el modelo de 17 segmentos. Posteriormente se analizó de manera retrospectiva su asociación con la mortalidad por cualquier causa y el efecto de la revascularización guiada por la RMC. Resultados: Durante una mediana de seguimiento de 4,58 años, se registraron 430 muertes (17,2%). Una mayor carga isquémica fue un predictor independiente de mortalidad: razón de riesgos, 1,04; intervalos de confianza del 95%, 1,01-1,07 por cada segmento adicional isquémico; p = 0,006). Esta asociación también ocurrió en los mayores de 80 años y en las mujeres (p < 0,001). Se detectó una interacción entre la revascularización y la mortalidad hacia un efecto deletéreo a baja carga isquémica y un efecto protector en caso de isquemia grave.[EN] Introduction and objectives: The management of elderly patients with chronic coronary syndrome (CCS) is challenging. We explored the prognostic value and usefulness for decision-making of ischemic burden determined by vasodilator stress cardiac magnetic resonance (CMR) imaging in elderly patients with known or suspected CCS. Methods: The study group comprised 2496 patients older than 70 years who underwent vasodilator stress CMR for known or suspected CCS. The ischemic burden (number of segments with stress-induced perfusion deficit) was calculated following the 17-segment model. Subsequently, we retrospectively analyzed its association with all-cause mortality and the effect of CMR-guided revascularization. Results: During a median follow-up of 4.58 years, there were 430 deaths (17.2%). A higher ischemic burden was an independent predictor of mortality (HR, 1.04; 95%CI, 1.01-1.07 for each additional ischemic segment; P = .006). This association was also found in patients older than 80 years and in women (P < .001). An interaction between revascularization and mortality was detected toward deleterious consequences at low ischemic burden and a protective effect in patients with extensive ischemia. Conclusions: Vasodilator stress CMR is a valuable tool to stratify risk in elderly patients with CCS and might be helpful to guide decision-making in this scenario.This study has been jointly funded by the Instituto de Salud Carlos III, the Fondo Europeo de Desarrollo Regional (FEDER) and the Sociedad Espanola de Cardiologia and Fundacion Espanola del Corazon [References: PI17/01836, CIBERCV16/11/00486 and SEC/FEC-INV-CLI 21/024].Gabaldón-Pérez, A.; Bonanad, C.; García-Blas, S.; Gavara-Doñate, J.; Ríos-Navarro, C.; Pérez-Solé, N.; De Dios, E.... (2022). Stress cardiac magnetic resonance for mortality prediction and decision-making: registry of 2496 elderly patients with chronic coronary syndrome. Revista Española de Cardiología. 75(3):223-231. https://doi.org/10.1016/j.rec.2021.08.00422323175