Marc Sirol1, Heger Gzara2, Etienne Gayat3, Raphael Dautry4, Barnabas Gellen5, Damien Logeart6, Philippe Soyer4, Eric Vicaut7, Jean-Jacques Mercadier8,9. 1. Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM UMR 1018 ; EpReC Team Assistance Publique - Hôpitaux de Paris, Imagerie Cardiaque et Vasculaire interventionnelle, Hôpital Ambroise Paré, 9 avenue du Général De Gaulle, 92104, Boulogne-Billancourt, France. marc.sirol@gmail.com. 2. Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM UMR 1018 ; EpReC Team Assistance Publique - Hôpitaux de Paris, Imagerie Cardiaque et Vasculaire interventionnelle, Hôpital Ambroise Paré, 9 avenue du Général De Gaulle, 92104, Boulogne-Billancourt, France. 3. Department of Anesthesiology and Critical Care Medicine and Clinical Epidemiology and Biostatistics, Lariboisière University Hospital, Paris, France. 4. Université Paris-Diderot, Sorbonne Paris Cité, 10 Avenue de Verdun, 75010, Paris, France. 5. Cardiology Department, CHU de Poitiers, Poitiers, France. 6. Service de Cardiologie, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, INSERM U942, Université Paris Diderot, Paris, France. 7. Unité de Recherche Clinique, Saint Louis - Lariboisière - Fernand Widal University Hospital, AP-HP, Paris, France. 8. AP-HP; Université Paris Diderot, Sorbonne Paris Cité, Paris, France. 9. UMR-S 1180, INSERM, Université Paris-Sud, Université Paris-Saclay, Châtenay-Malabry, France.
Abstract
OBJECTIVES: Current methods for infarct size and microvascular obstruction (MVO) quantification by cardiac magnetic resonance (CMR) imaging rely on planimetry. This method is time-consuming. We sought to evaluate a direct assessment of MVO severity based on visual evaluation and to compare it to a reference method. METHODS: CMR was performed in 112 consecutive patients after reperfused myocardial infarction. MVO was estimated by direct visual assessment based on a three-grade severity scale (MVO 1, mild; MVO 2, moderate; MVO 3, severe) on late gadolinium-enhancement (LGE). RESULTS: MVO was present in 69 patients (61.6 %). Quantitative MVO extent significantly increased accordingly to visual MVO grading (p < 0.01). Correlation between visual grading and quantitative assessment was excellent (r = 0.92, IQR 0.88-0.95, p < 0.001). CMR inter- and intraobserver variability for visual MVO evaluation was low (κ = 0.93 and κ = 0.96, respectively), whereas quantitative MVO assessment suffered from moderate agreement (interobserver, bias = -0.81 ± 1.8 g LV; intraobserver, -0.83 ± 2.1 g LV). Visual evaluation was significantly faster than reference method (0.65 ± 0.37 vs. 10.2 ± 2.9 min, p < 0.0001). CONCLUSIONS: MVO severity based on direct visual assessment on LGE images is feasible, rapid, reproducible and agrees very well with quantitative methods, with a very low inter- and intraobserver variability. Our approach could be used for routine evaluation in patients undergoing CMR after acute myocardial infarction. KEY POINTS: • Microvascular obstruction direct visual evaluation is feasible, rapid and highly reproducible. • Microvascular obstruction direct visual evaluation correlates well with quantification by planimetry. • Microvascular obstruction or no-reflow phenomenon is determined on late gadolinium-enhanced images. • Cardiac MRI is useful for myocardial damage assessment after myocardial infarction.
OBJECTIVES: Current methods for infarct size and microvascular obstruction (MVO) quantification by cardiac magnetic resonance (CMR) imaging rely on planimetry. This method is time-consuming. We sought to evaluate a direct assessment of MVO severity based on visual evaluation and to compare it to a reference method. METHODS: CMR was performed in 112 consecutive patients after reperfused myocardial infarction. MVO was estimated by direct visual assessment based on a three-grade severity scale (MVO 1, mild; MVO 2, moderate; MVO 3, severe) on late gadolinium-enhancement (LGE). RESULTS: MVO was present in 69 patients (61.6 %). Quantitative MVO extent significantly increased accordingly to visual MVO grading (p < 0.01). Correlation between visual grading and quantitative assessment was excellent (r = 0.92, IQR 0.88-0.95, p < 0.001). CMR inter- and intraobserver variability for visual MVO evaluation was low (κ = 0.93 and κ = 0.96, respectively), whereas quantitative MVO assessment suffered from moderate agreement (interobserver, bias = -0.81 ± 1.8 g LV; intraobserver, -0.83 ± 2.1 g LV). Visual evaluation was significantly faster than reference method (0.65 ± 0.37 vs. 10.2 ± 2.9 min, p < 0.0001). CONCLUSIONS: MVO severity based on direct visual assessment on LGE images is feasible, rapid, reproducible and agrees very well with quantitative methods, with a very low inter- and intraobserver variability. Our approach could be used for routine evaluation in patients undergoing CMR after acute myocardial infarction. KEY POINTS: • Microvascular obstruction direct visual evaluation is feasible, rapid and highly reproducible. • Microvascular obstruction direct visual evaluation correlates well with quantification by planimetry. • Microvascular obstruction or no-reflow phenomenon is determined on late gadolinium-enhanced images. • Cardiac MRI is useful for myocardial damage assessment after myocardial infarction.
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