Ejection Fraction by Echocardiography for a Selective Use of Magnetic Resonance After Infarction.
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.
['Marcos-Garces|Victor|V|', 'Gavara|Jose|J|', 'Lopez-Lereu|Maria P|MP|', 'Monmeneu|Jose V|JV|', 'Rios-Navarro|Cesar|C|', 'de Dios|Elena|E|', 'Perez|Nerea|N|', 'Cànoves|Joaquim|J|', 'Gonzalez|Jessika|J|', 'Minana|Gema|G|', 'Nunez|Julio|J|', 'de la Espriella|Rafael|R|', 'Santas|Enrique|E|', 'Moratal|David|D|', 'Chorro|Francisco J|FJ|', 'Valente|Filipa|F|', 'Lorenzatti|Daniel|D|', 'Rodríguez-Palomares|Jose F|JF|', 'Ortiz-Pérez|Jose T|JT|', 'Bodi|Vicente|V|']
D000368:Aged D004452:Echocardiography D005260:Female D006333:Heart Failure D006801:Humans D019028:Magnetic Resonance Imaging, Cine D008297:Male D008875:Middle Aged D010359:Patient Readmission D062645:Percutaneous Coronary Intervention D011237:Predictive Value of Tests D011446:Prospective Studies D012042:Registries D015203:Reproducibility of Results D000072657:ST Elevation Myocardial Infarction D013318:Stroke Volume D013997:Time Factors D016896:Treatment Outcome D018487:Ventricular Dysfunction, Left D016277:Ventricular Function, Left
echocardiography magnetic resonance risk myocardial infarction ventricular ejection fraction heart failure prognosis