Prognostic significance of infarct core pathology revealed by quantitative non-contrast in comparison with contrast cardiac magnetic resonance imaging in reperfused ST-elevation myocardial infarction survivors.

David Carrick,Ahmed Mahrous,Colin Berry,Niko Tzemos,Aleksandra Radjenovic,Caroline Haig,Hany Eteiba,Nadeem Ahmed,Keith G Oldroyd,Margaret Mcentegart,Ify Mordi,Paul Welsh,Mitchell Lindsay,Sam Rauhalammi,Stuart Hood,Stuart Watkins,Ian Ford,Naveed Sattar,Mark C Petrie

doi:10.1093/eurheartj/ehv372

David Carrick, Ahmed Mahrous + Show 17 more

Open Access

https://doi.org/10.1093/eurheartj/ehv372

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Abstract

AimsTo assess the prognostic significance of infarct core tissue characteristics using cardiac magnetic resonance (CMR) imaging in survivors of acute ST-elevation myocardial infarction (STEMI).Methods and resultsWe performed an observational prospective single centre cohort study in 300 reperfused STEMI patients (mean ± SD age 59 ± 12 years, 74% male) who underwent CMR 2 days and 6 months post-myocardial infarction (n = 267). Native T1 was measured in myocardial regions of interest (n = 288). Adverse remodelling was defined as an increase in left ventricular (LV) end-diastolic volume ≥20% at 6 months. All-cause death or first heart failure hospitalization was a pre-specified outcome that was assessed during follow-up (median duration 845 days). One hundred and sixty (56%) patients had a hypo-intense infarct core disclosed by native T1. In multivariable regression, infarct core native T1 was inversely associated with adverse remodelling [odds ratio (95% confidence interval (CI)] per 10 ms reduction in native T1: 0.91 (0.82, 0.00); P = 0.061). Thirty (10.4%) of 288 patients died or experienced a heart failure event and 13 of these events occurred post-discharge. Native T1 values (ms) within the hypo-intense infarct core (n = 160 STEMI patients) were inversely associated with the risk of all-cause death or first hospitalization for heart failure post-discharge (for a 10 ms increase in native T1: hazard ratio 0.730, 95% CI 0.617, 0.863; P < 0.001) including after adjustment for left ventricular ejection fraction, infarct core T2 and myocardial haemorrhage. The prognostic results for microvascular obstruction were similar.ConclusionInfarct core native T1 represents a novel non-contrast CMR biomarker with potential for infarct characterization and prognostication in STEMI survivors. Confirmatory studies are warranted.ClinicalTrials.gov identifierNCT02072850.

Highlights

Myocardial infarct size[1,2] and microvascular obstruction[3,4,5] revealed by contrast-enhanced cardiac magnetic resonance (CMR) reflect the efficacy of reperfusion therapy and are prognostically important findings in survivors of ST-elevation myocardial infarction (STEMI).Human tissue has fundamental magnetic properties, including the longitudinal relaxation time
Infarct core pathology revealed by native T1 mapping was feasible [n 1⁄4 288 (96%) with evaluable data] and had superior prognostic value compared with infarct core T2 and myocardial haemorrhage, and similar prognostic value compared with microvascular obstruction revealed by late gadolinium enhancement CMR
Of 343 STEMI patients referred for emergency reperfusion therapy, 300 underwent serial CMR at 1.5 T 2.2 + 1.9 days and 6 months after hospital admission (Figure 2)

Summary

Introduction

Myocardial infarct size[1,2] and microvascular obstruction[3,4,5] revealed by contrast-enhanced cardiac magnetic resonance (CMR) reflect the efficacy of reperfusion therapy and are prognostically important findings in survivors of ST-elevation myocardial infarction (STEMI).Human tissue has fundamental magnetic properties, including the longitudinal (spin-lattice) relaxation time (native T1 in milliseconds). Myocardial infarct size[1,2] and microvascular obstruction[3,4,5] revealed by contrast-enhanced cardiac magnetic resonance (CMR) reflect the efficacy of reperfusion therapy and are prognostically important findings in survivors of ST-elevation myocardial infarction (STEMI). We hypothesized that baseline native T1 values would be (i) inversely associated with the severity of MI, including microvascular obstruction, (ii) independently associated with left ventricular (LV) remodelling, and (iii) independently associated with predefined health outcomes. Should these hypotheses be confirmed infarct core native T1 mapping without an intravenous contrast agent might have potential as an alternative biomarker to microvascular obstruction revealed by contrast-enhanced CMR

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Conclusion