6533b7dcfe1ef96bd1271693

RESEARCH PRODUCT

Ejection Fraction by Echocardiography for a Selective Use of Magnetic Resonance After Infarction

Joaquim CànovesNerea PerezRafael De La EspriellaJose V. MonmeneuElena De DiosDavid MoratalMaria Pilar López‐lereuVicente BodiJose GavaraJessika GonzálezEnrique SantasJosé Rodríguez-palomaresVíctor Marcos-garcésJulio NúñezJosé T. Ortiz-pérezGema MiñanaFilipa ValenteDaniel LorenzattiCesar Rios-navarroFrancisco J. Chorro

subject

MaleRiskmedicine.medical_specialtyVentricular Ejection FractionTime FactorsInfarctionMagnetic Resonance Imaging CineHeart failurePatient ReadmissionVentricular Function LeftTECNOLOGIA ELECTRONICAVentricular Dysfunction LeftPercutaneous Coronary InterventionPredictive Value of TestsInternal medicinemedicineHumansVentricular ejection fractionRadiology Nuclear Medicine and imagingcardiovascular diseasesMyocardial infarctionProspective StudiesRegistriesAgedEjection fractionmedicine.diagnostic_testbusiness.industryReproducibility of ResultsMagnetic resonance imagingStroke VolumeMiddle Agedmedicine.diseasePrognosisNet reclassification improvementMyocardial infarctionTreatment OutcomeEchocardiographyMagnetic resonanceHeart failurecardiovascular systemCardiologyST Elevation Myocardial InfarctionFemaleCardiology and Cardiovascular MedicinebusinessMacecirculatory and respiratory physiology

description

[EN] 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= 50%: 7%, 40%-49%: 9%, = 50% (629, 56%), and they had a low MACE rate (57/629, 9%). In patients with echocardiography-LVEF= 40% (24/278, 9%) but significantly increased in patients with CMR-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.

yearjournalcountryeditionlanguage
2020-12-01
10.1161/circimaging.120.011491https://doi.org/10.1161/circimaging.120.011491