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Prognostic implication of global myocardial blood flow in patients with ST-segment elevation myocardial infarction

Rikuta Hamaya1,2, Yoshihisa Kanaji1, Masahiro Hada1

  • 1Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-4-1 Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan.

Heart and Vessels
|February 28, 2020
PubMed

Insights

Cardiovascular magnetic resonance imaging (CMR)-derived hyperemic myocardial blood flow (MBF) offers significant prognostic value in ST-elevation myocardial infarction (STEMI) patients. This advanced marker improves risk prediction for major adverse cardiac events beyond traditional imaging techniques.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Biomarkers

Background:

  • Prognostic implications of hyperemic myocardial blood flow (MBF) assessed by cardiovascular magnetic resonance imaging (CMR) in ST-elevation myocardial infarction (STEMI) patients remain unclear.
  • Conventional CMR markers like left-ventricular ejection fraction (LVEF), late gadolinium enhancement (LGE), and microvascular obstruction (MVO) are established prognostic indicators post-STEMI.
  • Identifying high-risk patients after STEMI is crucial for timely intervention and improved patient outcomes.

Purpose of the Study:

  • To evaluate the incremental prognostic value of CMR-derived hyperemic MBF compared to conventional CMR markers in STEMI patients.
  • To identify patients at high risk for future patient-oriented composite outcomes (POCO) and major adverse cardiac events (MACE) after STEMI.
  • To determine if hyperemic MBF adds predictive power to existing risk stratification models.

Main Methods:

  • Prospective enrollment of 237 STEMI patients.
  • CMR protocol included LVEF, LGE, MVO, and volumetric hyperemic MBF assessment.
  • Multivariable analysis and propensity score matching were used to assess prognostic value and outcomes over a median 2.6-year follow-up.

Main Results:

  • Multivessel disease, LGE, MVO, and hyperemic MBF were independently associated with POCO.
  • Addition of hyperemic MBF significantly improved the predictive efficacy of a model including GRACE score, multivessel disease, LVEF, LGE, and MVO (IDI = 0.020, p = 0.021).
  • Patients with low hyperemic MBF exhibited a significantly higher incidence of MACE compared to those with high hyperemic MBF (p = 0.018).

Conclusions:

  • CMR-derived hyperemic MBF provides independent and incremental prognostic value in STEMI patients.
  • Hyperemic MBF assessment enhances risk stratification beyond traditional CMR parameters like LVEF, LGE, and MVO.
  • This finding supports the integration of hyperemic MBF into routine CMR protocols for improved post-STEMI risk assessment.

Keywords:
Cardiovascular magnetic resonance imagingCoronary flow reserveMyocardial blood flowST-segment elevation myocardial infarction

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