Assessment of viability of a myocardium by MDCT method for predicting remodelling LV after myocardial imfarction

The purpose of this work was to evaluate of viability of a myocardium and assessment prognostic value of myocardial contrast delayed enhancement with 64-slice multidetector computed tomography after ST-elevation acute myocardial infarction (AMI). Methods. In study were included 117 patients with first AMI. Multidetector computed tomography (MDCT) with contrast enhancement was performed in all patients in 3-5 days and at 12 month after AMI. In arterial phase were evaluation myocardial perfusion defect, end-systolic, end-diastolic volume and ejection fraction of LV. In delay phase we detected 3 types of contrast enhancement of infarct zone: subendocardial residual defect (RD) (viable myocardium - type 1), transmural myocardial contrast delayed enhancement (DE) with or without RD (nonviable myocardium - 1and 2 types). LV remodelling was defined as an increase in LVEDV of >20 % at 12 months after infarction compared with that based on measurements in individual patients. Results. Myocardial perfusion defect was less in patients with viable myocardium 1 [0.4-2.4] versus 7.3 [5.3-10.0] and 6.3 [5.0-15.0] in patients with DE and with or without RD, respectively, p<0.001. During the 12-month period, LV remodelling was observed in 19.3 % patients with non-viable myocardium. Multivariable Cox proportional hazards regression analysis indicated that the number of LV segments with transmural DE (infarct size) was a significant independent predictor for the prediction of LV remodelling. Conclusions. The number of LV segments with transmural DE on MDCT may provide promising information for predicting LV remodelling and cardiac events in patients with AMI.

острый инфаркт миокарда, нежизнеспособный миокард, ремоделирование левого желудочка, мультиспиральная компьютерная томография, acute myocardial infarction, nonviable myocardium, left ventricular remodeling, multidetector computed tomography

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