Assessment of unrecognized myocardial infarction using cardiac magnetic resonance imaging in patients with endstage renal disease

Avaliação de infarto do miocárdio não reconhecido usando ressonância magnética cardíaca em pacientes com doença renal em estágio terminal

Abstract

Objective:   To assess the frequency of unrecognized myocardial infarction and identify additional ischemic conditions, as well as to evaluate the efficacy of cardiac magnetic resonance imaging (CMRI) in risk groups, comparing the imaging findings with electro-cardiographic (ECG) and laboratory data in patients with stage 5 chronic kidney disease, also known as end-stage renal disease.

Materials and Methods:   This was a prospective single-center study involving 20 patients who were referred to our radiology department to undergo CMRI between June 2010 and December 2011. Resting left ventricular functions and (early and late) myocardial contrast enhancement were assessed in all patients. Laboratory tests and ECG were conducted on all individuals. The mean duration of clinical follow-up was 18 ± 4 months.

Results:   Pathological results were seen in six (30%) of the patients in our study sample. Scar tissue was identified as a high-risk factor in three patients (15%), and myocardial hibernation was shown to pose a moderate risk in three patients (15%). In the remaining 14 cases, no pathology was identified, and the risk was therefore categorized as low. A statistically significant disparity in mortality rates was observed between the high- and low-risk groups (p < 0.05). There were no statistically significant differences between the two groups in terms of the ECG and cardiac biomarkers.

Conclusion:   Our findings indicate that CMRI is effective in accurately categorizing risk groups and detecting ischemic conditions, even when such events are not evident on ECG or laboratory tests.

Keywords:
Magnetic resonance imaging/methods; Kidney failure, chronic; Contrast media/metabolism; Myocardial infarction/diagnosis