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Persistent Iron Within the Infarct Core After ST-Segment Elevation Myocardial Infarction: Implications for Left
Jaclyn Carberry1, David Carrick2, Caroline Haig3
1British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland.
Insights
Persistent iron after ST-segment elevation myocardial infarction (STEMI) is linked to poorer heart function and increased risk of death or heart failure. This finding highlights the prognostic significance of iron in STEMI patients.
Area of Science:
- Cardiology
- Medical Imaging
- Biomarkers
Background:
- The clinical significance of persistent iron in the infarct core after ST-segment elevation myocardial infarction (STEMI) with acute myocardial hemorrhage is not well understood.
- Iron deposition in the myocardium post-STEMI may influence long-term outcomes.
Purpose of the Study:
- To determine the incidence of persistent iron in patients following STEMI.
- To investigate the prognostic significance of persistent iron on cardiac function and clinical outcomes.
Main Methods:
- A cohort of 203 STEMI patients underwent cardiac magnetic resonance imaging (CMR) with T2* mapping at 2 days and 6 months post-STEMI.
- Myocardial hemorrhage/iron was defined as a hypointense infarct core with T2* signal <20 ms.
- Clinical outcomes including all-cause death, heart failure, and major adverse cardiac events were tracked over a median of 1,457 days.
Main Results:
- Persistent iron was identified in 59% of patients with baseline myocardial hemorrhage at 6 months post-STEMI.
- Persistent iron was associated with increased heart rate, absence of hypertension history, and larger infarct size.
- Persistent iron correlated with worsening left ventricular (LV) end-diastolic volume and reduced LV ejection fraction.
- Persistent iron significantly increased the risk of all-cause death or heart failure (HR: 3.91) and major adverse cardiac events (HR: 3.24).
Conclusions:
- Persistent myocardial iron at 6 months post-STEMI is a significant predictor of adverse left ventricular remodeling.
- The presence of persistent iron is associated with worse long-term health outcomes, including increased mortality and heart failure.
- T2* mapping in STEMI patients can identify persistent iron, offering prognostic value for patient management.
Objectives:
This study sought to determine the incidence and prognostic significance of persistent iron in patients post-ST-segment elevation myocardial infarction (STEMI).
Background:
The clinical significance of persistent iron within the infarct core after STEMI complicated by acute myocardial hemorrhage is poorly understood.
Methods:
Patients who sustained an acute STEMI were enrolled in a cohort study (BHF MR-MI [Detection and Significance of Heart Injury in ST Elevation Myocardial Infarction]). Cardiac magnetic resonance imaging including T2* (observed time constant for the decay of transverse magnetization seen with gradient-echo sequences) mapping was performed at 2 days and 6 months post-STEMI. Myocardial hemorrhage or iron was defined as a hypointense infarct core with T2* signal <20 ms.
Results:
A total of 203 patients (age 57 ± 11 years, n = 158 [78%] male) had evaluable T2* maps at 2 days and 6 months post-STEMI; 74 (36%) patients had myocardial hemorrhage at baseline, and 44 (59%) of these patients had persistent iron at 6 months. Clinical associates of persistent iron included heart rate (p = 0.009), the absence of a history of hypertension (p = 0.017), and infarct size (p = 0.028). The presence of persistent iron was associated with worsening left ventricular (LV) end-diastolic volume (regression coefficient: 21.10; 95% confidence interval [CI]: 10.92 to 31.27; p < 0.001) and worsening LV ejection fraction (regression coefficient: -6.47; 95% CI: -9.22 to -3.72; p < 0.001). Persistent iron was associated with the subsequent occurrence of all-cause death or heart failure (hazard ratio: 3.91; 95% CI: 1.37 to 11.14; p = 0.011) and major adverse cardiac events (hazard ratio: 3.24; 95% CI: 1.09 to 9.64; p = 0.035) (median follow-up duration 1,457 days [range 233 to 1,734 days]).
Conclusions:
Persistent iron at 6 months post-STEMI is associated with worse LV and longer-term health outcomes. (Detection and Significance of Heart Injury in ST Elevation Myocardial Infarction [BHF MR-MI]; NCT02072850).
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