Comparison of Magnetic Resonance Analysis of Myocardial Scarring With Biomarker Release Following S-T Elevation Myocardial Infarction

Benedict T. Costello, Dion Stub, James Hare, Andris H. Ellims, Xinyu Wang, Karen Smith, Stephen Bernard, Ziad Nehme, Michael Stephenson, Janet E. Bray, Peter Cameron, Bill Barger, Ian T. Meredith, David M. Kaye, Leah Iles, Andrew J. Taylor, on behalf of the AVOID Investigators

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Late gadolinium enhancement (LGE) with cardiac magnetic resonance (CMR) is commonly assumed to represent myocardial fibrosis; however, comparative human histological data are limited, and there is no consensus on the most accurate method for LGE quantitation. We evaluated the relationship between CMR assessment of regional fibrosis and infarct size assessment using serial biomarkers after ST elevation acute myocardial infarction (STEMI). Methods: Ninety-three patients treated for STEMI (59. ±. 10 years, 86% male) underwent CMR 6 months after infarction. Infarct size was quantified by CMR-LGE using manual and range of semi-automated thresholds (range: 2-10 standard deviations [SD]) above reference myocardium and the full width-half maximum (FWHM) technique, and compared with the rise in serum biomarkers. The agreement between CMR and biomarker in the identification of large infarcts based on peak troponin (TnI) levels was also analysed. Results: Quantification methods had a strong influence on the infarct size assessment with CMR-LGE. Significant correlations were observed between LGE and biomarkers across all of the signal intensity thresholds. Whilst there was a wide variation with respect to the estimation of total LGE size (from 6.8. ±. 7.7 to 32.1. ±. 11.3 grams), the variation in the correlation with peak troponin level was much smaller (r-values ranging from 0.670 to 0.876). There was good agreement between CMR-LGE and biomarker assessment of infarct size; the best agreement between CMR-LGE and large infarction using a threshold of 8SD for peak TnI. >. 50. ng/mL (Cohen's kappa (κ) = 0.722), and a threshold of 4SD for peak TnI >. 95. ng/mL (κ = 0.761). Conclusions: The correlation between CMR-LGE quantification of infarct size and biomarker release following STEMI at a range of semi-automated thresholds was consistently strong, with good agreement between measures across a range of thresholds.

Original languageEnglish
Pages (from-to)397-405
Number of pages9
JournalHeart Lung and Circulation
Volume28
Issue number3
DOIs
Publication statusPublished - Mar 2019

Keywords

  • Cardiac magnetic resonance
  • Fibrosis
  • Infarct size
  • Late gadolinium enhancement

Cite this

@article{c8025d2eb1d141e998c7beb25f898077,
title = "Comparison of Magnetic Resonance Analysis of Myocardial Scarring With Biomarker Release Following S-T Elevation Myocardial Infarction",
abstract = "Background: Late gadolinium enhancement (LGE) with cardiac magnetic resonance (CMR) is commonly assumed to represent myocardial fibrosis; however, comparative human histological data are limited, and there is no consensus on the most accurate method for LGE quantitation. We evaluated the relationship between CMR assessment of regional fibrosis and infarct size assessment using serial biomarkers after ST elevation acute myocardial infarction (STEMI). Methods: Ninety-three patients treated for STEMI (59. ±. 10 years, 86{\%} male) underwent CMR 6 months after infarction. Infarct size was quantified by CMR-LGE using manual and range of semi-automated thresholds (range: 2-10 standard deviations [SD]) above reference myocardium and the full width-half maximum (FWHM) technique, and compared with the rise in serum biomarkers. The agreement between CMR and biomarker in the identification of large infarcts based on peak troponin (TnI) levels was also analysed. Results: Quantification methods had a strong influence on the infarct size assessment with CMR-LGE. Significant correlations were observed between LGE and biomarkers across all of the signal intensity thresholds. Whilst there was a wide variation with respect to the estimation of total LGE size (from 6.8. ±. 7.7 to 32.1. ±. 11.3 grams), the variation in the correlation with peak troponin level was much smaller (r-values ranging from 0.670 to 0.876). There was good agreement between CMR-LGE and biomarker assessment of infarct size; the best agreement between CMR-LGE and large infarction using a threshold of 8SD for peak TnI. >. 50. ng/mL (Cohen's kappa (κ) = 0.722), and a threshold of 4SD for peak TnI >. 95. ng/mL (κ = 0.761). Conclusions: The correlation between CMR-LGE quantification of infarct size and biomarker release following STEMI at a range of semi-automated thresholds was consistently strong, with good agreement between measures across a range of thresholds.",
keywords = "Cardiac magnetic resonance, Fibrosis, Infarct size, Late gadolinium enhancement",
author = "Costello, {Benedict T.} and Dion Stub and James Hare and Ellims, {Andris H.} and Xinyu Wang and Karen Smith and Stephen Bernard and Ziad Nehme and Michael Stephenson and Bray, {Janet E.} and Peter Cameron and Bill Barger and Meredith, {Ian T.} and Kaye, {David M.} and Leah Iles and Taylor, {Andrew J.} and {on behalf of the AVOID Investigators}",
year = "2019",
month = "3",
doi = "10.1016/j.hlc.2018.02.007",
language = "English",
volume = "28",
pages = "397--405",
journal = "Heart Lung and Circulation",
issn = "1443-9506",
publisher = "Elsevier",
number = "3",

}

Comparison of Magnetic Resonance Analysis of Myocardial Scarring With Biomarker Release Following S-T Elevation Myocardial Infarction. / Costello, Benedict T.; Stub, Dion; Hare, James; Ellims, Andris H.; Wang, Xinyu; Smith, Karen; Bernard, Stephen; Nehme, Ziad; Stephenson, Michael; Bray, Janet E.; Cameron, Peter; Barger, Bill; Meredith, Ian T.; Kaye, David M.; Iles, Leah; Taylor, Andrew J.; on behalf of the AVOID Investigators.

In: Heart Lung and Circulation, Vol. 28, No. 3, 03.2019, p. 397-405.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Comparison of Magnetic Resonance Analysis of Myocardial Scarring With Biomarker Release Following S-T Elevation Myocardial Infarction

AU - Costello, Benedict T.

AU - Stub, Dion

AU - Hare, James

AU - Ellims, Andris H.

AU - Wang, Xinyu

AU - Smith, Karen

AU - Bernard, Stephen

AU - Nehme, Ziad

AU - Stephenson, Michael

AU - Bray, Janet E.

AU - Cameron, Peter

AU - Barger, Bill

AU - Meredith, Ian T.

AU - Kaye, David M.

AU - Iles, Leah

AU - Taylor, Andrew J.

AU - on behalf of the AVOID Investigators

PY - 2019/3

Y1 - 2019/3

N2 - Background: Late gadolinium enhancement (LGE) with cardiac magnetic resonance (CMR) is commonly assumed to represent myocardial fibrosis; however, comparative human histological data are limited, and there is no consensus on the most accurate method for LGE quantitation. We evaluated the relationship between CMR assessment of regional fibrosis and infarct size assessment using serial biomarkers after ST elevation acute myocardial infarction (STEMI). Methods: Ninety-three patients treated for STEMI (59. ±. 10 years, 86% male) underwent CMR 6 months after infarction. Infarct size was quantified by CMR-LGE using manual and range of semi-automated thresholds (range: 2-10 standard deviations [SD]) above reference myocardium and the full width-half maximum (FWHM) technique, and compared with the rise in serum biomarkers. The agreement between CMR and biomarker in the identification of large infarcts based on peak troponin (TnI) levels was also analysed. Results: Quantification methods had a strong influence on the infarct size assessment with CMR-LGE. Significant correlations were observed between LGE and biomarkers across all of the signal intensity thresholds. Whilst there was a wide variation with respect to the estimation of total LGE size (from 6.8. ±. 7.7 to 32.1. ±. 11.3 grams), the variation in the correlation with peak troponin level was much smaller (r-values ranging from 0.670 to 0.876). There was good agreement between CMR-LGE and biomarker assessment of infarct size; the best agreement between CMR-LGE and large infarction using a threshold of 8SD for peak TnI. >. 50. ng/mL (Cohen's kappa (κ) = 0.722), and a threshold of 4SD for peak TnI >. 95. ng/mL (κ = 0.761). Conclusions: The correlation between CMR-LGE quantification of infarct size and biomarker release following STEMI at a range of semi-automated thresholds was consistently strong, with good agreement between measures across a range of thresholds.

AB - Background: Late gadolinium enhancement (LGE) with cardiac magnetic resonance (CMR) is commonly assumed to represent myocardial fibrosis; however, comparative human histological data are limited, and there is no consensus on the most accurate method for LGE quantitation. We evaluated the relationship between CMR assessment of regional fibrosis and infarct size assessment using serial biomarkers after ST elevation acute myocardial infarction (STEMI). Methods: Ninety-three patients treated for STEMI (59. ±. 10 years, 86% male) underwent CMR 6 months after infarction. Infarct size was quantified by CMR-LGE using manual and range of semi-automated thresholds (range: 2-10 standard deviations [SD]) above reference myocardium and the full width-half maximum (FWHM) technique, and compared with the rise in serum biomarkers. The agreement between CMR and biomarker in the identification of large infarcts based on peak troponin (TnI) levels was also analysed. Results: Quantification methods had a strong influence on the infarct size assessment with CMR-LGE. Significant correlations were observed between LGE and biomarkers across all of the signal intensity thresholds. Whilst there was a wide variation with respect to the estimation of total LGE size (from 6.8. ±. 7.7 to 32.1. ±. 11.3 grams), the variation in the correlation with peak troponin level was much smaller (r-values ranging from 0.670 to 0.876). There was good agreement between CMR-LGE and biomarker assessment of infarct size; the best agreement between CMR-LGE and large infarction using a threshold of 8SD for peak TnI. >. 50. ng/mL (Cohen's kappa (κ) = 0.722), and a threshold of 4SD for peak TnI >. 95. ng/mL (κ = 0.761). Conclusions: The correlation between CMR-LGE quantification of infarct size and biomarker release following STEMI at a range of semi-automated thresholds was consistently strong, with good agreement between measures across a range of thresholds.

KW - Cardiac magnetic resonance

KW - Fibrosis

KW - Infarct size

KW - Late gadolinium enhancement

UR - http://www.scopus.com/inward/record.url?scp=85042910702&partnerID=8YFLogxK

U2 - 10.1016/j.hlc.2018.02.007

DO - 10.1016/j.hlc.2018.02.007

M3 - Article

VL - 28

SP - 397

EP - 405

JO - Heart Lung and Circulation

JF - Heart Lung and Circulation

SN - 1443-9506

IS - 3

ER -