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Function of remote non-infarcted myocardium after STEMI: analysis with cardiovascular magnetic resonance
Oliver Husser1, Fabian Chaustre, Juan Sanchis
1Cardiology Department, Hospital Clinico Universitario, INCLIVA, Universidad de Valencia, Blasco Ibanez 17, 46010 Valencia, Spain.
Insights
Remote myocardial function after ST-elevation myocardial infarction (STEMI) is generally preserved. Only small infarcts show improved contractility at six months, while medium and large infarcts do not differ from controls.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Myocardial Infarction Research
Background:
- ST-elevation myocardial infarction (STEMI) can affect remote myocardial function.
- Assessing remote myocardial function and the impact of infarct size is crucial for understanding long-term outcomes.
Purpose of the Study:
- To evaluate remote myocardial function after STEMI.
- To determine the impact of infarct size on remote myocardial function using cardiovascular magnetic resonance (CMR).
Main Methods:
- 161 STEMI patients and 15 controls underwent CMR at 1 week and 6 months post-STEMI.
- The 17-segment model categorized myocardium into infarcted, adjacent, and remote segments.
- Relative systolic wall thickening (SWT) and infarct size (IS) were assessed using centerline and late enhancement imaging, respectively.
Main Results:
- Remote myocardial SWT was comparable to controls at 1 week and did not significantly increase at 6 months.
- No significant difference in remote SWT was observed compared to controls, irrespective of infarct size at 1 week.
- At 6 months, only small infarcts showed significantly increased remote SWT compared to controls (P=.03); medium and large infarcts did not.
Conclusions:
- Remote myocardial contractility is generally preserved after STEMI.
- A slight hypercontractility in remote myocardium is observed only in small infarcts at 6 months.
- In medium and large STEMI, remote myocardial function remains comparable to controls.
Abstract:
To evaluate remote myocardial function after ST-elevation myocardial infarction (STEMI) and the impact of infarct size (IS) using cardiovascular magnetic resonance (CMR). 161 patients and 15 controls underwent CMR at 1st week and 6th month after STEMI. Using the 17-segments model, segments were categorized into infarcted, adjacent and remote myocardium. Relative systolic wall thickening (SWT, %) was assessed using the centerline method. IS (% of left ventricular mass) was determined in late enhancement imaging. Overall, in remote myocardium, SWT was comparable (83 ± 32) to controls (77 ± 25, P = .5) and did not increase significantly (P = .2) at the 6th month (88 ± 35, P = .3 vs. control). When IS was categorized into tertiles (<13.6%, (n = 49), 13.7-28.2%, (n = 60), >28.2%, (n = 52)), SWT in the remote area at the 1st week was not different from controls, regardless of infarct size (p between .2 and .8 for all tertiles). At 6 months, SWT was larger compared to controls only in small infarctions (98 ± 34 vs. 77 ± 25, P = .03). In medium and large infarctions there was no difference in SWT of the remote area compared to controls (87 ± 33 and 79 ± 34, P = .3 and P = .09) and there was no significant increase at 6 months (P between .2 and .9). In remote myocardium there was no difference in contractility compared to controls after STEMI. After 6 month a slight hypercontractility can only be observed in small infarctions. In medium and large infarctions no difference of SWT in remote myocardium compared to controls can be observed.
