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Prognostic Significance of Remote Myocardium Alterations Assessed by Quantitative Noncontrast T1 Mapping in
Sebastian J Reinstadler1, Thomas Stiermaier2, Johanna Liebetrau2
1University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany; University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria.
Insights
Native T1 mapping in the remote myocardium of ST-segment elevation myocardial infarction (STEMI) patients predicts clinical events. This cardiac magnetic resonance (CMR) technique offers incremental prognostic value beyond traditional markers for improved risk stratification.
Area of Science:
- Cardiology
- Medical Imaging
- Biomarkers
Background:
- The prognostic significance of remote myocardium native T1 alterations after ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI) is not fully understood.
- Cardiac magnetic resonance (CMR) native T1 mapping assesses tissue characteristics, but its incremental value in predicting outcomes post-STEMI requires further investigation.
Purpose of the Study:
- To evaluate the prognostic significance of remote zone native T1 alterations in STEMI patients treated with PPCI.
- To compare the predictive capability of native T1 mapping with conventional markers of infarct severity.
Main Methods:
- Included 255 STEMI patients reperfused within 12 hours.
- Assessed left ventricular (LV) function, infarct characteristics, and remote myocardium native T1 values using CMR.
- Primary endpoint was a composite of major adverse cardiac events (MACE) within 6 months.
Main Results:
- Increased remote zone native T1 values correlated with larger infarcts, less myocardial salvage, and worse LV function.
- Remote zone native T1 was independently associated with MACE after adjusting for clinical and CMR variables.
- Native T1 mapping provided incremental prognostic information beyond traditional risk factors and CMR markers, improving risk reclassification.
Conclusions:
- Quantitative noncontrast T1 mapping of the remote myocardium offers independent and incremental prognostic information in STEMI patients treated with PPCI.
- Remote zone alterations identified by T1 mapping may serve as a novel therapeutic target and a valuable parameter for optimized risk stratification.
Objectives:
This study assessed the prognostic significance of remote zone native T1 alterations for the prediction of clinical events in a population with ST-segment elevation myocardial infarction (STEMI) who were treated by primary percutaneous coronary intervention (PPCI) and compared it with conventional markers of infarct severity.
Background:
The exact role and incremental prognostic relevance of remote myocardium native T1 mapping alterations assessed by cardiac magnetic resonance (CMR) after STEMI remains unclear.
Methods:
We included 255 consecutive patients with STEMI who were reperfused within 12 h after symptom onset. CMR core laboratory analysis was performed to assess left ventricular (LV) function, standard infarct characteristics, and native T1 values of the remote, noninfarcted myocardium. The primary endpoint was a composite of death, reinfarction, and new congestive heart failure within 6 months (major adverse cardiac events [MACE]).
Results:
Patients with increased remote zone native T1 values (>1,129 ms) had significantly larger infarcts (p = 0.012), less myocardial salvage (p = 0.002), and more pronounced LV dysfunction (p = 0.011). In multivariable analysis, remote zone native T1 was independently associated with MACE after adjusting for clinical risk factors (p = 0.001) or other CMR variables (p = 0.007). In C-statistics, native T1 of remote myocardium provided incremental prognostic information beyond clinical risk factors, LV ejection fraction, and other markers of infarct severity (all p < 0.05). The addition of remote zone native T1 to a model of prognostic CMR parameters (ejection fraction, infarct size, and myocardial salvage index) led to net reclassification improvement of 0.82 (95% confidence interval: 0.46 to 1.17; p < 0.001) and to an integrated discrimination improvement of 0.07 (95% confidence interval: 0.02 to 0.13; p = 0.01).
Conclusions:
In STEMI patients treated by PPCI, evaluation of remote zone alterations by quantitative noncontrast T1 mapping provided independent and incremental prognostic information in addition to clinical risk factors and traditional CMR outcome markers. Remote zone alterations may thus represent a novel therapeutic target and a useful parameter for optimized risk stratification. (Effect of Conditioning on Myocardial Damage in STEMI [LIPSIA-COND]; NCT02158468).
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