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Splenic tissue alterations in ST-elevation myocardial infarction: determinants and prognostic implications

Ting-Xuan Yin1, Guo-Jun Zhu1, Xing-Yu Gu1

  • 1Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 PuJian Rd, Pudong New Area, Shanghai 200127, China.

European Heart Journal. Cardiovascular Imaging
|April 21, 2026
PubMed

Insights

Cardiac magnetic resonance (CMR) can detect splenic T1 alterations after ST-segment-elevation myocardial infarction (STEMI). Elevated splenic T1 z-score and extracellular volume (ECV) predict major adverse cardiovascular events (MACE), offering improved risk prediction.

Area of Science:

  • Cardiology
  • Radiology
  • Biomedical Imaging

Background:

  • The cardio-splenic axis suggests splenic involvement in systemic inflammation post-myocardial infarction.
  • Clinical significance of splenic tissue changes on cardiac magnetic resonance (CMR) in ST-segment-elevation myocardial infarction (STEMI) is not well-defined.

Purpose of the Study:

  • To identify determinants of splenic T1 patterns in STEMI patients using CMR.
  • To investigate the association between splenic T1 patterns and adverse cardiovascular outcomes.

Main Methods:

  • Retrospective analysis of STEMI patients undergoing CMR within 10 days of primary percutaneous coronary intervention.
  • Evaluation of splenic T1 times and extracellular volume (ECV) using CMR.
  • Follow-up for major adverse cardiovascular events (MACE) including cardiovascular death, heart failure, and re-infarction.

Main Results:

  • Elevated splenic T1 z-score and splenic ECV independently predicted MACE in multivariable Cox regression.
  • These splenic alterations were primarily associated with increased risk of heart failure and non-target vessel re-infarction.
  • A model incorporating splenic T1 z-score with clinical and myocardial imaging factors showed superior discrimination for MACE prediction.

Conclusions:

  • Splenic T1 z-score and ECV measured by CMR after STEMI are independent predictors of MACE.
  • These findings provide incremental prognostic value beyond traditional risk markers.
  • Splenic imaging may enhance risk stratification in STEMI patients.
Abstract

Keywords:
cardio-splenic axisextracellular volumemagnetic resonance imagingmyocardial infarctionprognosist1 mapping

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