CMR imaging for the evaluation of myocardial stunning after acute myocardial infarction

A meta-analysis of prospective trials

Jorge E. Romero, Jonathan Kahan, Iosif Kelesidis, Harikrishna Makani, Omar Wever-Pinzon, Hector Medina, Mario J. Garcia

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

BackgroundMyocardial stunning is an important sequela of acute coronary syndromes and its determination might affect decisions on defibrillator implantation and assist devices after myocardial infarction (AMI). The aim of the study was to evaluate and compare the sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of cardiac magnetic resonance imaging (CMR) assessing myocardial stunning after acute myocardial infarction using low-dose dobutamine (LDD), end-diastolic wall thickness, and contrast delayed enhancement (DE).Methods and resultsA systematic review of Medline, Embase, and Cochrane for all prospective trials assessing myocardial stunning by CMR following AMI was performed using a standard approach for meta-analysis for diagnostic test and a bivariate analysis. Search results revealed 9384 studies, out of which 17 met criteria. A total of 634 patients (mean age 59 years, 85% male, mean left ventricular ejection fraction: 52%) were included. DE-CMR had a weighted sensitivity of 87% and specificity of 68% to detect myocardial stunning using 50% transmurality as a cut-off, with a PPV and NPV of 83 and 72%, respectively. With an overall diagnostic accuracy of 82%, LDD-CMR had a sensitivity of 67% and a specificity of 81%, with a PPV and NPV of 82 and 63%, respectively. LDD showed an overall accuracy of 74%.ConclusionDE-CMR has a higher sensitivity, whereas LDD-CMR has a higher specificity for the detection of viable stunned myocardium following myocardial infarction. Whether the combination of DE and LDD may improve the prediction of myocardial recovery remains to be determined.

Original languageEnglish (US)
Pages (from-to)1080-1091
Number of pages12
JournalEuropean Heart Journal Cardiovascular Imaging
Volume14
Issue number11
DOIs
StatePublished - Nov 2013

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Myocardial Stunning
Dobutamine
Meta-Analysis
Myocardial Infarction
Magnetic Resonance Imaging
Sensitivity and Specificity
Defibrillators
Acute Coronary Syndrome
Routine Diagnostic Tests
Stroke Volume
Equipment and Supplies

Keywords

  • Cardiac magnetic resonance imaging
  • Myocardial stunning
  • Myocardial viability
  • Revascularization

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

CMR imaging for the evaluation of myocardial stunning after acute myocardial infarction : A meta-analysis of prospective trials. / Romero, Jorge E.; Kahan, Jonathan; Kelesidis, Iosif; Makani, Harikrishna; Wever-Pinzon, Omar; Medina, Hector; Garcia, Mario J.

In: European Heart Journal Cardiovascular Imaging, Vol. 14, No. 11, 11.2013, p. 1080-1091.

Research output: Contribution to journalArticle

Romero, Jorge E. ; Kahan, Jonathan ; Kelesidis, Iosif ; Makani, Harikrishna ; Wever-Pinzon, Omar ; Medina, Hector ; Garcia, Mario J. / CMR imaging for the evaluation of myocardial stunning after acute myocardial infarction : A meta-analysis of prospective trials. In: European Heart Journal Cardiovascular Imaging. 2013 ; Vol. 14, No. 11. pp. 1080-1091.
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AU - Wever-Pinzon, Omar

AU - Medina, Hector

AU - Garcia, Mario J.

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N2 - BackgroundMyocardial stunning is an important sequela of acute coronary syndromes and its determination might affect decisions on defibrillator implantation and assist devices after myocardial infarction (AMI). The aim of the study was to evaluate and compare the sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of cardiac magnetic resonance imaging (CMR) assessing myocardial stunning after acute myocardial infarction using low-dose dobutamine (LDD), end-diastolic wall thickness, and contrast delayed enhancement (DE).Methods and resultsA systematic review of Medline, Embase, and Cochrane for all prospective trials assessing myocardial stunning by CMR following AMI was performed using a standard approach for meta-analysis for diagnostic test and a bivariate analysis. Search results revealed 9384 studies, out of which 17 met criteria. A total of 634 patients (mean age 59 years, 85% male, mean left ventricular ejection fraction: 52%) were included. DE-CMR had a weighted sensitivity of 87% and specificity of 68% to detect myocardial stunning using 50% transmurality as a cut-off, with a PPV and NPV of 83 and 72%, respectively. With an overall diagnostic accuracy of 82%, LDD-CMR had a sensitivity of 67% and a specificity of 81%, with a PPV and NPV of 82 and 63%, respectively. LDD showed an overall accuracy of 74%.ConclusionDE-CMR has a higher sensitivity, whereas LDD-CMR has a higher specificity for the detection of viable stunned myocardium following myocardial infarction. Whether the combination of DE and LDD may improve the prediction of myocardial recovery remains to be determined.

AB - BackgroundMyocardial stunning is an important sequela of acute coronary syndromes and its determination might affect decisions on defibrillator implantation and assist devices after myocardial infarction (AMI). The aim of the study was to evaluate and compare the sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of cardiac magnetic resonance imaging (CMR) assessing myocardial stunning after acute myocardial infarction using low-dose dobutamine (LDD), end-diastolic wall thickness, and contrast delayed enhancement (DE).Methods and resultsA systematic review of Medline, Embase, and Cochrane for all prospective trials assessing myocardial stunning by CMR following AMI was performed using a standard approach for meta-analysis for diagnostic test and a bivariate analysis. Search results revealed 9384 studies, out of which 17 met criteria. A total of 634 patients (mean age 59 years, 85% male, mean left ventricular ejection fraction: 52%) were included. DE-CMR had a weighted sensitivity of 87% and specificity of 68% to detect myocardial stunning using 50% transmurality as a cut-off, with a PPV and NPV of 83 and 72%, respectively. With an overall diagnostic accuracy of 82%, LDD-CMR had a sensitivity of 67% and a specificity of 81%, with a PPV and NPV of 82 and 63%, respectively. LDD showed an overall accuracy of 74%.ConclusionDE-CMR has a higher sensitivity, whereas LDD-CMR has a higher specificity for the detection of viable stunned myocardium following myocardial infarction. Whether the combination of DE and LDD may improve the prediction of myocardial recovery remains to be determined.

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