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Updated: Jul 16, 2026
Myocardial Infarction and Functional Outcome Assessment in Pigs
Published on: April 25, 2014
Infarct Zone Circumferential Strain Independently Predicts Left Ventricular Functional Recovery After ST-Segment
Agneta Virbickiene1,2, Olivija Dobiliene2, Arnoldas Leleika2
1Institute of Cardiology, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania.
Insights
Segmental cardiac magnetic resonance imaging parameters, including infarct zone circumferential strain, predict left ventricular functional recovery after ST-segment elevation myocardial infarction (STEMI). These findings improve prognostic accuracy for patients post-primary percutaneous coronary intervention (PCI).
Area of Science:
- Cardiology
- Medical Imaging
- Biomedical Engineering
Background:
- Cardiac magnetic resonance (CMR) is crucial for assessing myocardial injury post-ST-elevation myocardial infarction (STEMI).
- The prognostic value of segmental infarct zone parameters for left ventricular (LV) functional recovery needs further definition.
- Primary percutaneous coronary intervention (PCI) is a standard STEMI treatment.
Purpose of the Study:
- To evaluate if segmental infarct zone functional and structural CMR parameters predict LV functional recovery after STEMI treated with primary PCI.
- To compare the prognostic value of segmental parameters versus global indices.
- To identify key CMR-derived predictors of adverse LV remodeling.
Main Methods:
- Prospective single-center study of 93 first STEMI patients post-PCI.
- CMR assessment at baseline and 6-month follow-up.
- Comprehensive CMR included cine, feature-tracking strain, T1/T2 mapping, and late gadolinium enhancement (LGE) for infarct size (IS) and microvascular obstruction (MVO).
Main Results:
- Significant reverse remodeling observed at 6 months: improved LV ejection fraction (LVEF) and decreased LV end-systolic volume and relative IS.
- Circumferential strain (CS) in the infarct zone was the strongest independent predictor of unfavorable LV functional recovery (OR 8.81, p=0.004).
- Relative IS (OR 4.02, p=0.045) and infarct zone post-contrast T1 (OR 4.40, p=0.034) also predicted recovery.
Conclusions:
- Segmental infarct zone characteristics, particularly CS, post-contrast T1, and IS, are clinically relevant predictors of LV functional recovery post-STEMI.
- Infarct zone CS provides incremental prognostic value beyond structural parameters.
- These findings highlight the importance of segmental analysis for predicting myocardial recovery and guiding patient management.
Abstract:
Background/Objectives: Cardiac magnetic resonance (CMR) imaging provides a comprehensive assessment of myocardial injury after ST-segment elevation myocardial infarction (STEMI), yet the relative prognostic value of segmental infarct zone parameters compared with global indices for predicting left ventricular (LV) functional recovery remains incompletely defined. This study aimed to determine whether segmental infarct zone functional and structural CMR parameters provide prognostic information for LV functional recovery after a first STEMI treated with primary percutaneous coronary intervention (PCI). Methods: In this prospective single-center study, 93 patients with a first STEMI (median age 61 years; 77% male) underwent CMR at baseline (median 3 days post-PCI) and at a 6-month follow-up. The comprehensive CMR assessment included cine imaging for volumetric and feature-tracking strain analysis, T1 and T2 mapping, and late gadolinium enhancement (LGE) for infarct size (IS) and microvascular obstruction (MVO) quantification. The myocardial segments were classified as infarcted, adjacent, or remote based on the LGE distribution. The primary outcome was unfavorable LV functional recovery, defined as failure to achieve an absolute increase of >10 percentage points in the LV ejection fraction (LVEF) or a follow-up LVEF ≤ 50%. Results: At the 6-month follow-up, significant reverse remodeling was observed: the LVEF improved from 49.0% [40.7-52.4] to 55.8% [47.9-59.9] (p < 0.001), the LV end-systolic volume decreased from 91.8 mL [75.1-113.8] to 80.8 mL [61.9-108.3] (p = 0.005), and the relative IS decreased from 30.9% [18.9-45.5] to 19.0% [11.1-31.3] of LV mass (p < 0.001). At the follow-up, MVO was no longer detectable in any patient. Unfavorable functional recovery occurred in 17 patients (18.3%). In the multivariable analysis, the infarct zone circumferential strain (CS) was the strongest independent predictor of unfavorable recovery (OR 8.81; 95% CI 1.98-39.28; p = 0.004), followed by the relative IS (OR 4.02; 95% CI 1.03-15.73; p = 0.045) and a lower infarct zone post-contrast T1 (OR 4.40; 95% CI 1.12-17.36; p = 0.034). Conclusions: Segmental infarct zone characteristics-particularly circumferential strain, post-contrast T1, and infarct size-provide clinically relevant prognostic information for LV functional recovery after STEMI. The infarct zone CS offers incremental predictive value beyond its structural parameters, reflecting the residual contractile reserve and myocardial viability.
