Hepatic Tissue Alterations in ST-Elevation Myocardial Infarction: Determinants and Prognostic Implications

Area of Science:

• Cardiology
• Radiology
• Biomedical Imaging

Background:

• The clinical significance of hepatic tissue changes in ST-segment-elevation myocardial infarction (STEMI) patients, assessed via cardiac magnetic resonance imaging (CMR), remains unclear.
• This study investigates the relationship between hepatic T1 patterns and myocardial damage, as well as clinical outcomes in STEMI patients.

Purpose of the Study:

• To explore the association of hepatic T1 patterns with myocardial damage and clinical outcomes in STEMI patients.
• To determine if hepatic tissue alterations detected by CMR T1 mapping predict adverse cardiovascular events post-STEMI.

Main Methods:

• Analysis of 485 STEMI patients from the MARINA STEMI study, treated with percutaneous coronary intervention.
• Assessment of myocardial function, infarct characteristics, and ventricular function using CMR within the first week post-STEMI.
• Evaluation of native hepatic T1 times and extracellular volume from cardiac T1 maps at baseline and 4-month follow-up.

Main Results:

• Median hepatic T1 times decreased from baseline (559 ms) to 4 months (542 ms) post-STEMI (P<0.001).
• Baseline hepatic T1 times were associated with female sex, hyperlipidemia, infarct size, microvascular obstruction, and right ventricular (RV) infarction.
• Hepatic T1 times at 4 months were linked to female sex, multivessel disease, N-terminal pro-B-type natriuretic peptide, RV infarction, and RV end-systolic volume index.
• Patients without a decrease in hepatic T1 times had a higher incidence of major adverse cardiovascular events (13% vs. 5%; P=0.003).
• Hepatic T1 times at baseline and 4 months, and hepatic extracellular volume at 4 months, were associated with major adverse cardiovascular events.
• After adjustment, only 4-month hepatic T1 times independently predicted adverse outcomes (HR, 2.86; P<0.001).

Conclusions:

• Hepatic tissue alterations, identified by T1 mapping, correlate with patient characteristics and myocardial damage in STEMI.
• These hepatic changes can persist into the chronic phase after STEMI.
• Persistent hepatic T1 alterations are indicative of a worse clinical prognosis and increased risk of major adverse cardiovascular events.