Myocardial Infarct Size by CMR in Clinical Cardioprotection Studies Insights From Randomized Controlled Trials

JACC-CARDIOVASCULAR IMAGING

卷:10

Article

Bulluck, Heerajnarain^1,2,3  Hammond-Haley, Matthew¹  Weinmann, Shane¹  Martinez-Macias, Roberto¹  Hausenloy, Derek J.^1,2,3,4 

[1] UCL, Inst Cardiovasc Sci, Hatter Cardiovasc Inst, London, England

[2] UCL, Hosp Biomed Res Ctr, Natl Inst Hlth Res, London, England

[3] Natl Heart Ctr Singapore, Natl Heart Res Inst Singapore, Singapore, Singapore

[4] Duke Natl Univ Singapore, Cardiovasc & Metab Disorders Program, Singapore, Singapore

关键词: cardiovascular magnetic;    resonance;    myocardial infarct size;    primary;    percutaneous coronary intervention;    randomized controlled trial;    sample size;    ST-segment elevation myocardial infarction;   

DOI  :  10.1016/j.jcmg.2017.01.008

来源: Elsevier

【 摘 要 】

OBJECTIVES The aim of this study was to review randomized controlled trials (RCTs) using cardiac magnetic resonance (CMR) to assess myocardial infarct (MI) size in reperfused patients with ST-segment elevation myocardial infarction (STEMI). BACKGROUND There is limited guidance on the use of CMR in clinical cardioprotection RCTs in patients with STEMI treated by primary percutaneous coronary intervention. METHODS All RCTs in which CMR was used to quantify MI size in patients with STEMI treated with primary percutaneous coronary intervention were identified and reviewed. RESULTS Sixty-two RCTs (10,570 patients, January 2006 to November 2016) were included. One-third did not report CMR vendor or scanner strength, the contrast agent and dose used, and the MI size quantification technique. Gadopentetate dimeglumine was most commonly used, followed by gadoterate meglumine and gadobutrol at 0.20 mmol/kg each, with late gadolinium enhancement acquired at 10 min; in most RCTs, MI size was quantified manually, followed by the 5 standard deviation threshold; dropout rates were 9% for acute CMR only and 16% for paired acute and follow-up scans. Weighted mean acute and chronic MI sizes (5=12 h, initial TIMI [Thrombolysis in Myocardial Infarction] flow grade 0 to 3) from the control arms were 21 +/- 14% and 15 +/- 11% of the left ventricle, respectively, and could be used for future sample-size calculations. Pre-selecting patients most likely to benefit from the cardioprotective therapy (56 h, initial TIMI flow grade 0 or 1) reduced sample size by one-third. Other suggested recommendations for standardizing CMR in future RCTs included gadobutrol at 0.15 mmol/kg with late gadolinium enhancement at 15 min, manual or 6-SD threshold for MI quantification, performing acute CMR at 3 to 5 days and follow-up CMR at 6 months, and adequate reporting of the acquisition and analysis of CMR. CONCLUSIONS There is significant heterogeneity in RCT design using CMR in patients with STEMI. The authors provide recommendations for standardizing the assessment of MI size using CMR in future clinical cardioprotection RCTs. (J Am Coll Cardiol Img 2017;10:230-40) (C)2017 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY license .

【 授权许可】

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