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In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Relationship and prognostic value of microvascular obstruction and infarct size in ST-elevation myocardial infarction
Suzanne de Waha1, Steffen Desch, Ingo Eitel
1Department of Internal Medicine, Cardiology, University of Leipzig-Heart Center, Strümpellstr. 39, Leipzig, 04289, Germany. s-dw@gmx.net
Background:
Both infarct size and microvascular obstruction (MO) assessed by cardiac magnetic resonance imaging (CMR) are known to be predictors for adverse clinical outcome after ST-elevation myocardial infarction (STEMI). We hypothesized that a ratio of MO and infarct size (MO/infarct size) might be an even stronger predictor for outcome after STEMI, which has not been investigated yet.
Methods:
STEMI patients reperfused by primary angioplasty (n = 438) within 12 h after symptom onset underwent contrast-enhanced CMR at a median of 3 days (interquartile range [IQR] 2;4) after the index event. MO and infarct size were measured 15 min after intravenous gadolinium injection. Follow-up was conducted after 19 months (IQR 10;27). The primary end point was defined as a composite of death, non-fatal myocardial reinfarction and congestive heart failure (major adverse cardiac events [MACE]).
Results:
The extent of MO was only weakly correlated with infarct size (r = 0.21, p < 0.001). In a first multivariate analysis including extent of MO, infarct size, ejection fraction, end-systolic and end-diastolic volume, the extent of MO was independently associated with MACE (hazard ratio [HR] 1.03, 95%CI 1.02–1.05, p < 0.001). In a second multivariate analysis including MO/infarct size on top of the extent of MO, infarct size, ejection fraction, end-systolic and end-diastolic volume, MO/infarct size was identified as the strongest independent predictor for MACE (HR 2.22 [95%CI 1.60–3.08, p < 0.001]).
Conclusions:
In contrast to infarct size, MO is associated with adverse clinical outcome after STEMI even after adjustment for other CMR parameters. However, MO/infarct size is a more powerful predictor for long-term outcome after STEMI than either parameter alone.
Insights
The ratio of microvascular obstruction (MO) to infarct size is a stronger predictor of major adverse cardiac events after ST-elevation myocardial infarction (STEMI) than either measure alone. This finding improves risk stratification for STEMI patients.
Area of Science:
- Cardiology
- Medical Imaging
- Clinical Research
Background:
- Cardiac magnetic resonance imaging (CMR) assesses infarct size and microvascular obstruction (MO) after ST-elevation myocardial infarction (STEMI).
- Both infarct size and MO predict adverse outcomes, but their combined predictive power, especially a ratio, remains understudied.
Purpose of the Study:
- To investigate whether the ratio of microvascular obstruction (MO) to infarct size is a stronger predictor of major adverse cardiac events (MACE) after STEMI compared to MO or infarct size alone.
- To evaluate the independent predictive value of MO/infarct size ratio in STEMI patients.
Main Methods:
- A cohort of 438 STEMI patients undergoing primary angioplasty within 12 hours of symptom onset were assessed using contrast-enhanced CMR.
- Microvascular obstruction (MO) and infarct size were quantified. Follow-up for MACE (death, reinfarction, heart failure) was conducted over 19 months.
Main Results:
- Microvascular obstruction (MO) was independently associated with MACE.
- The MO/infarct size ratio emerged as the strongest independent predictor of MACE (HR 2.22, p < 0.001), outperforming individual measures.
- MO extent showed only a weak correlation with infarct size (r = 0.21).
Conclusions:
- The MO/infarct size ratio is a more potent predictor of long-term MACE after STEMI than infarct size or MO alone.
- This ratio enhances risk stratification for STEMI patients undergoing primary angioplasty.
- CMR-derived MO/infarct size ratio offers valuable prognostic information beyond traditional metrics.
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