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. 2018 Feb 8;18(1):27.
doi: 10.1186/s12872-018-0767-7.

Peak CK-MB has a strong association with chronic scar size and wall motion abnormalities after revascularized non-transmural myocardial infarction - a prospective CMR study

Pauli Pöyhönen  1 , Minna Kylmälä  2 , Paula Vesterinen  2 , Sari Kivistö  3 , Miia Holmström  3 , Kirsi Lauerma  3 , Heikki Väänänen  4 , Lauri Toivonen  2 , Helena Hänninen  2
Affiliations

Peak CK-MB has a strong association with chronic scar size and wall motion abnormalities after revascularized non-transmural myocardial infarction - a prospective CMR study

Pauli Pöyhönen et al. BMC Cardiovasc Disord. .

Abstract

Background: Large myocardial infarction (MI) is associated with adverse left ventricular (LV) remodeling (LVR). We studied the nature of LVR, with specific attention to non-transmural MIs, and the association of peak CK-MB with recovery and chronic phase scar size and LVR.

Methods: Altogether 41 patients underwent prospectively repeated cardiovascular magnetic resonance at a median of 22 (interquartile range 9-29) days and 10 (8-16) months after the first revascularized MI. Transmural MI was defined as ≥75% enhancement in at least one myocardial segment.

Results: Peak CK-MB was 86 (40-216) μg/L in median, while recovery and chronic phase scar size were 13 (3-23) % and 8 (2-19) %. Altogether 33 patients (81%) had a non-transmural MI. Peak CK-MB had a strong correlation with recovery and chronic scar size (r ≥ 0.80 for all, r ≥ 0.74 for non-transmural MIs; p < 0.001). Peak CK-MB, recovery scar size, and chronic scar size, were all strongly correlated with chronic wall motion abnormality index (WMAi) (r ≥ 0.75 for all, r ≥ 0.73 for non-transmural MIs; p < 0.001). There was proportional scar size and LV mass resorption of 26% (0-50%) and 6% (- 2-14%) in median. Young age (< 60 years, median) was associated with greater LV mass resorption (median 9%vs.1%, p = 0.007).

Conclusions: Peak CK-MB has a strong association with chronic scar size and wall motion abnormalities after revascularized non-transmural MI. Considerable infarct resorption happens after the first-month recovery phase. LV mass resorption is related to age, being more common in younger patients.

Keywords: Acute myocardial infarction; Cardiovascular magnetic resonance; Coronary artery disease; Creatine kinase-MB; Infarct transmurality; Left ventricular remodeling.

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Conflict of interest statement

Ethics approval and consent to participate

All participants gave written informed consent and the study was approved by the ethics committee of the Helsinki University Hospital.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Study flow chart (a). Correlation of peak CK-MB with recovery (b) and chronic (c) scar size at CMR (n = 41). Correlation of recovery scar size with scar size change between CMRs (d); only patients with visible scar (n = 35) included. Correlation of age with left ventricular (LV) mass change between CMRs (e) (n = 41). Abbreviations: CMR cardiovascular magnetic resonance, MI myocardial infarction, UAP unstable angina pectoris, MACE major adverse cardiac event
Fig. 2
Fig. 2
Correlation of peak CK-MB (a, b), recovery scar size (c, d) and chronic scar size (e, f) with chronic ejection fraction (EF) and wall motion abnormality index (WMAi) (n = 41)
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