Prognostic Value of Scar Spatial Properties on CMR for Major Adverse Cardiovascular Events After Myocardial...

Area of Science:

• Cardiology
• Medical Imaging
• Biomedical Engineering

Background:

• The border zone (BZ) on cardiac magnetic resonance (CMR) imaging is crucial for major adverse cardiac events (MACEs) after myocardial infarction (MI).
• Conventional BZ assessment lacks the ability to characterize spatial properties of abnormal electrical conduction (BZC).
• Novel methods are needed to better predict MACEs by evaluating BZC spatial features.

Purpose of the Study:

• To evaluate ADAS 3D-quantified BZ channel (BZC) spatial features as novel predictors of MACEs in post-MI patients.
• To determine if BZC spatial characteristics offer prognostic value beyond conventional CMR scar parameters.

Main Methods:

• Retrospective analysis of post-MI patients with ADAS 3D BZC assessment.
• Quantitative analysis of scar spatial properties (BZC number, mass, length, transmurality, complexity) from late gadolinium enhancement (LGE) images.
• Prognostic modeling using univariate and LASSO-Cox regression, with model performance assessed by C-index, calibration curves, and decision curve analysis (DCA).

Main Results:

• Patients with MACEs showed impaired global longitudinal strain (GLS), left atrioventricular coupling index (LACI), greater scar mass, and higher BZC spatial characteristics.
• LASSO-Cox regression identified total BZC mass as the sole independent predictor for primary (arrhythmic outcomes) and secondary (arrhythmic outcomes, all-cause mortality, heart failure rehospitalization) endpoints.
• ADAS 3D-derived total BZC mass demonstrated strong discriminative ability for predicting MACEs.

Conclusions:

• ADAS 3D-derived BZC spatial characteristics are independent predictors of MACEs in post-MI patients.
• Total BZC mass, a novel spatial parameter, shows significant prognostic performance.
• These findings suggest that advanced CMR-based BZC spatial analysis can improve MACE risk stratification.