Prognostic impact of remote myocardium changes using T1 mapping in patients with ST-segment elevation myocardial
Fritz Oberhollenzer1, Ivan Lechner1, Martin Reindl1
1University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria.
Insights
Remote extracellular volume (ECV) measured by cardiac magnetic resonance (CMR) T1 mapping predicts major adverse cardiac events (MACE) after ST-segment elevation myocardial infarction (STEMI). This finding highlights ECV as a valuable tool for risk stratification in STEMI patients.
Area of Science:
- Cardiology
- Medical Imaging
- Biomarkers
Background:
- ST-segment elevation myocardial infarction (STEMI) is a critical cardiovascular event.
- Assessing remote myocardium changes post-STEMI is crucial for prognosis.
- Cardiac magnetic resonance (CMR) T1 mapping offers detailed myocardial tissue characterization.
Purpose of the Study:
- To evaluate the prognostic significance of remote myocardium alterations using CMR T1 mapping (native T1 and extracellular volume [ECV]).
- To determine if native T1 and ECV measurements can predict major adverse cardiac events (MACE) in STEMI patients.
Main Methods:
- Retrospective analysis of STEMI patients treated with primary percutaneous coronary intervention (PCI).
- CMR imaging assessed left ventricular (LV) function, infarct characteristics, remote native T1, and remote ECV.
- Primary endpoint was a composite of all-cause mortality, re-infarction, and new congestive heart failure (MACE).
Main Results:
- Higher remote native T1 and remote ECV values were observed in patients who experienced MACE.
- Multivariable Cox regression identified remote ECV as an independent predictor of MACE (HR: 1.53, p=0.020).
- Remote native T1 was not found to be an independent predictor of MACE.
Conclusions:
- Comprehensive assessment of the remote myocardium using native T1 and ECV provides prognostic information in STEMI patients.
- Remote ECV is an independent predictor of MACE, offering valuable insights for risk stratification.
- Quantification of ECV changes in the remote myocardium is a promising diagnostic tool for post-STEMI risk assessment.
Objectives:
The aim of this study was to investigate the prognostic relevance of remote myocardium alterations assessed by cardiac magnetic resonance (CMR) T1 mapping (native T1 and extracellular volume (ECV)) in patients after ST-segment elevation myocardial infarction (STEMI).
Materials And Methods:
This retrospective study analyzed STEMI patients treated with primary percutaneous coronary intervention (PCI) who were included in the prospective MARINA-STEMI study. CMR images were analyzed for left ventricular (LV) function, standard infarct characteristics, as well as native remote T1 and remote ECV. The primary clinical endpoint was the composite of all-cause mortality, re-infarction and new congestive heart failure (Major adverse cardiac events (MACE)).
Results:
Four hundred ninety-one patients (median age 58 [Interquartile range (IQR): 52-66 years], 91 (19%) female) patients underwent CMR imaging at 4 ([IQR: 3-5]) days after PCI. Over a median follow-up of 12 months ([IQR: 12-13]) after STEMI, 42 MACE outcomes occurred. Higher native remote T1-times (1018.5 [IQR: 997.0-1064.0] ms vs. 1007.0 [IQR: 977.0-1041.5] ms, p = 0.033) as well as higher remote ECV values (28.07 vs. 26.27%, p = 0.009) were observed in patients with MACE. Multivariable Cox-regression analysis demonstrated that remote ECV (hazard ratio (HR): 1.53 [confidence interval (CI): 1.07-2.19], p = 0.020) but not native remote T1 is independently associated with MACE.
Conclusions:
A comprehensive assessment of the remote myocardium with native T1 and ECV provides prognostic information in a contemporary cohort of low-risk STEMI patients. Remote ECV, but not remote native T1, was found to be an independent predictor of MACE.
Key Points:
Question The prognostic implications of remote myocardium changes assessed by cardiac magnetic resonance (CMR) T1 mapping in patients after ST-segment elevation myocardial infarction (STEMI) are not fully understood. Findings After STEMI, for patients treated with primary percutaneous coronary intervention, remote extracellular volume (ECV) was found to be an independent predictor of major adverse cardiac events. Clinical relevance This study underlines the importance of remote myocardium characterization as a promising diagnostic tool. In particular, the quantification of ECV changes in the remote myocardium could be relevant for optimized CMR-imaging-based risk stratification in patients after STEMI.
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