Enhancement patterns on multidetector CT (MDCT) predict myocardial dysfunction and recovery after acute myocardial infarction (AMI), according to findings published in the September issue of Radiology. by Will Boggs, MD

"Cardiac CT has more to offer than just looking at coronaries," Dr. Jonathan Lessick from Rambam Health Care Campus, Haifa, Israel told Reuters Health. "It is a comprehensive test which enables one to combine anatomical and functional information (perfusion, function, viability). More specifically, it has prognostic value when applied in post-AMI patients."

Dr. Lessick and associates evaluated the relationship between early perfusion defects (ED) and late enhancement (LE) on MDCT and regional myocardial dysfunction and myocardial functional recovery in 30 patients with a first AMI using echocardiography as the reference standard.

All ED and LE were in the infarct territory determined by angiography and echocardiography and were associated with regional dysfunction at baseline echocardiography in all studies but one, the authors report.

Among patients with patent coronary arteries, the presence of an ED had 57 per cent sensitivity, 90 per cent specificity, and 82 per cent accuracy to predict follow-up segment dysfunction, while the presence of LE had 73 per cent sensitivity, 85 per cent specificity, and 82 per cent accuracy.

The presence of both ED and LE had a high specificity (94 per cent) but a low sensitivity (48 per cent) for predicting follow-up dysfunction.

ED and LE showed a similar, but weaker, ability to predict follow-up segment dysfunction among patients with occluded coronary arteries, the report indicates.

For patients with patent coronaries, the presence of ED or LE was also associated with a lower likelihood of myocardial functional recovery, the researchers note. There was a 55 per cent chance of recovery for segments with neither type of defect, an 18 per cent chance for segments with only one type of defect, and only a 12 per cent chance of functional recovery for segments with both defects.

In contrast, for patients with occluded coronary arteries, the relationship between ED and/or LE and myocardial functional recovery was opposite: the presence of ED or LE was associated with a higher chance of functional recovery.

"The ability to look at enhancement patterns/perfusion on CT is still in a preliminary phase," Dr. Lessick said. "Future developments, especially the ability to scan the heart in a single heart beat, and more sensitive ways of detecting iodine such as multienergy scanners, have the potential to put CT in the forefront of perfusion analysis, thereby giving combined anatomical and functional information in the same study."


Source: Reuters