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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
Summary
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.
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