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Cardiac magnetic resonance for the early prediction of reverse left ventricular remodeling in patients with
Jianing Cui1, Yanan Zhao1, Geng Qian2
1Department of Radiology, the First Medical center, PLA General Hospital, Beijing, China.
Insights
Reverse left ventricular remodeling (r-LVR) in ST-segment elevation myocardial infarction (STEMI) patients is predicted by microvascular obstruction mass and infarct zone peak longitudinal displacement. These findings aid in developing new treatment strategies for STEMI patients.
Area of Science:
- Cardiology
- Medical Imaging
- Biomedical Engineering
Background:
- ST-segment elevation myocardial infarction (STEMI) is a critical condition requiring timely intervention.
- Reverse left ventricular remodeling (r-LVR) is a key factor influencing long-term outcomes after STEMI.
- Cardiac magnetic resonance (CMR) is a powerful tool for assessing myocardial structure and function.
Purpose of the Study:
- To evaluate changes in CMR characteristics in STEMI patients.
- To identify predictors of r-LVR in STEMI patients.
- To establish a foundation for parameter-guided treatment strategies post-STEMI.
Main Methods:
- Retrospective study of 86 STEMI patients, divided into r-LVR and without r-LVR groups.
- Comprehensive CMR analysis including LV volume, infarct characteristics, and myocardial function (global and regional).
- Assessment of strain and displacement using CMR-feature tracking, with logistic regression for predictor analysis.
Main Results:
- No initial differences in LV volume or global function between groups; higher infarct zone displacements in the r-LVR group.
- The r-LVR group demonstrated improved recovery with higher LVEF, lower LV volume, and reduced enhanced mass at follow-up CMR.
- Microvascular obstruction (MVO) mass and infarct zone peak longitudinal displacement (PLD) were identified as independent predictors of r-LVR.
Conclusions:
- Initial CMR showed higher infarct zone displacements in the r-LVR group, despite similar global function.
- STEMI patients with r-LVR experienced better recovery of myocardial injury and cardiac function.
- MVO mass and infarct zone PLD are significant predictors of r-LVR, offering targets for future therapeutic strategies.
Objectives:
To evaluate the changes in cardiac magnetic resonance (CMR) characteristics and investigate the predictors of reverse left ventricular remodeling (r-LVR) in ST-segment elevation myocardial infarction (STEMI) patients.
Materials And Methods:
Eighty-six STEMI patients (median 56 years) were retrospectively studied. The patients were divided into r-LVR and without r-LVR groups. CMR analysis included LV volume, infarct characteristics, and global and regional myocardial function. The strain and displacement were assessed by CMR-feature tracking. The predictors of r-LVR were analyzed by the logistic regression method.
Results:
There were 37 patients in the r-LVR group and 49 patients in the without r-LVR group. At initial CMR, there was no difference in LV volume and global cardiac function between the two groups. However, the infarct zone radial and longitudinal displacements were higher in the r-LVR group (p < 0.05, respectively). At the second CMR, the r-LVR group showed higher LVEF, lower LV volume, and total enhanced mass (all p < 0.05). The infarct zone radial and circumferential strains and radial displacement were higher in the r-LVR group (all p < 0.05). The r-LVR group had better recovery of myocardial injury and function. Of note, microvascular obstruction (MVO) mass (odds ratio: 0.779 (0.613-0.989), p = 0.041) and infarct zone peak longitudinal displacement (PLD) (odds ratio: 1.448 (1.044-2.008), p = 0.026) were independent predictors of r-LVR.
Conclusions:
At initial CMR, there were no differences in global cardiac function between the two groups, but infarct zone displacements were higher in the r-LVR group. The r-LVR group had better recovery of cardiac function. In addition, MVO mass and infarct zone PLD were independent predictors of r-LVR.
Clinical Relevance Statement:
Our study assessed changes in cardiac structure, function, and tissue characteristics after STEMI by CMR, investigated the best predictors of r-LVR in STEMI patients, and laid the foundation for the development of new parameter-guided treatment strategies for STEMI patients.
Key Points:
• At initial CMR, the reverse left ventricular remodeling (r-LVR) group had less myocardial damage and higher infarct zone displacement, but there were no differences in global function between the two groups. • Both groups showed recovery of myocardial injury and cardiac function over time, but the r-LVR group had less enhanced mass and better cardiac function compared to the without r-LVR group at the second CMR. • Microvascular obstruction mass and infarct zone peak longitudinal displacement by cardiac magnetic resonance feature-tracking were significant predictors of r-LVR in STEMI patients.
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