Cardiac MR Characterization of Infarct-Related and Remote Myocardial Injury in Multivessel Disease After Acute...

Area of Science:

• Cardiovascular Imaging
• Cardiac MRI
• Myocardial Infarction

Background:

• Patients with multivessel disease (MVD) post-acute myocardial infarction (AMI) experience poorer outcomes compared to single-vessel disease (SVD).
• The extent of diffuse myocardial injury beyond the infarct zone in MVD patients after AMI remains incompletely understood.

Purpose of the Study:

• To characterize myocardial tissue properties in the infarct-related and remote zones using cardiac MRI.
• To compare these properties between MVD and SVD patients following AMI.
• To explore differences based on the completeness of revascularization.

Main Methods:

• Retrospective analysis of 224 patients (90 SVD, 42 MVD with complete revascularization [CR], 92 MVD with incomplete revascularization [IR]) who underwent cardiac MRI 31-90 days post-PCI.
• Utilized 3.0T MRI with cine, late gadolinium enhancement (LGE), T1-mapping, and T2-mapping sequences.
• Quantified infarct size (LGE), native T1, extracellular volume (ECV), and T2 values in infarct zone (IZ), peri-infarct zone (PIZ), and remote zone (RZ).

Main Results:

• MVD patients exhibited larger infarct size and elevated native T1, ECV, and T2 values in PIZ and RZ compared to SVD patients, even after adjusting for clinical factors and infarct size.
• No significant differences in infarct size or ventricular function were observed between CR and IR groups within the MVD cohort.
• MVD patients with incomplete revascularization (IR) showed significantly higher ECV in PIZ and RZ, and elevated T2 in the RZ compared to those with complete revascularization (CR).

Conclusions:

• Multivessel disease (MVD) in acute myocardial infarction (AMI) is associated with diffuse myocardial injury extending into non-infarct areas.
• Revascularization completeness significantly impacts non-infarct myocardial tissue properties in MVD patients, with incomplete revascularization linked to greater injury.