Item Details

title

CARDIAC MAGNETIC RESONANCE IMAGING IN THE DIAGNOSIS OF MYOCARDIAL ISCHEMIA SUB-TYPES: PREDICTING MYOCARDIAL INFARCTION TYPE AND CLINICAL OUTCOMES

author

Park, Carolyn Jean

abstract

Objectives: The goal of this study is to investigate how non-contrasted cardiac magnetic resonance (CMR) parameters can predict the type of myocardial infarction (MI) and injury. Background: The incidence of type 2 MI and non-MI injury have increased compared to type 1 MI over the past two decades. Type 2 events are also associated with a higher mortality rate and can pose diagnostic challenges, especially with concomitant renal dysfunction where contrast use is contraindicated. There has been increasing interest in using non-contrast dependent or native CMR for studying ischemic heart disease. Methods: We conducted a sub-analysis of the Cardiac Magnetic Resonance Imaging Strategy for the Management of Patients With Acute Chest Pain and Detectable to Elevated Troponin (CMR-IMPACT; NCT01931852) trial. CMR parameters including native T1, T2, extracellular volume (ECV), native stress T1 response (ΔT1stress), and a novel parameter, Cregions (a function of the differences in native T1 between vascular regions of mid-myocardium), were analyzed in 103 subjects who presented to the emergency department with chest pain and detectable troponin-I levels and who all underwent CMR <24 hours of presentation. Multivariable regression models for non-plaque rupture MI and non-MI injury, as well as major adverse clinical outcomes, were performed by individual mid-myocardial segments and by regions. Results: Native T1 was a significant predictor for predicting non-plaque rupture vs plaque-rupture events (OR=1.01, [95% CI: 1.001–1.02]; P=0.04), while Cregions was the best predictor with OR=0.42 (95% CI: 0.21–0.87; P=0.01). Prediction models using ΔT1stress for MI/injury type yielded the best model performance with area under the receiver operating characteristic curve (AUROC) of 0.97. Models using only native CMR parameters including Cregions yielded AUROC of 0.89. Native T1 and Cregions were also predictive of all-cause mortality or MI at ~3 years following the index MI/injury (OR=1.03 and P=0.01; OR 4.98 and P=0.01, respectively). Conclusions: Native CMR parameters including native T1, ΔT1stress, and the novel Cregions index may discriminate between mechanisms of ischemia and predict future adverse clinical outcomes.

subject

cardiac magnetic resonance

CMR

coronary artery disease

ischemia

native T1

stress CMR

contributor

Miller, Chadwick D (committee chair)

Snavely, Anna C (committee member)

Jordan, Jennifer H (committee member)

date

2021-06-03T08:35:53Z (accessioned)

2023-06-02T08:30:11Z (available)

2021 (issued)

degree

Clinical and Population Translational Sciences (discipline)

embargo

2023-06-02 (terms)

identifier

http://hdl.handle.net/10339/98782 (uri)

language

en (iso)

publisher

Wake Forest University

type

Thesis