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Abstract
BackgroundTo investigate the influence of cardiovascular magnetic resonance (CMR) timing after reperfusion on CMR-derived parameters of ischemia/reperfusion (I/R) injury in patients with ST-segment elevation myocardial infarction (STEMI).MethodsThe study included 163 reperfused STEMI patients undergoing CMR during the index hospitalization. Patients were divided according to the time between revascularization and CMR (Trevasc-CMR: Tertile-1 ≤ 43; 43 < Tertile-2 ≤ 93; Tertile-3 > 93 h). T2-mapping derived area-at-risk (AAR) and intramyocardial-hemorrhage (IMH), and late gadolinium enhancement (LGE)-derived infarct size (IS) and microvascular obstruction (MVO) were quantified. T1-mapping was performed before and > 15 min after Gd-based contrast-agent administration yielding extracellular volume (ECV) of infarct.ResultsMain factors influencing I/R injury were homogenously balanced across Trevasc-CMR tertiles. T2 values of infarct and remote regions increased with increasing Trevasc-CMR tertiles (infarct: 60.0 ± 4.9 vs 63.5 ± 5.6 vs 64.8 ± 7.5 ms; P < 0.001; remote: 44.3 ± 2.8 vs 46.1 ± 2.8 vs ± 46.1 ± 3.0; P = 0.001). However, T2 value of infarct largely and significantly exceeded that of remote myocardium in each tertile yielding comparable T2-mapping-derived AAR extent throughout Trevasc-CMR tertiles (17 ± 9% vs 19 ± 9% vs 18 ± 8% of LV, respectively, P = 0.385). Similarly, T2-mapping-based IMH detection and quantification were independent of Trevasc-CMR. LGE-derived IS and MVO were not influenced by Trevasc-CMR (IS: 12 ± 9% vs 12 ± 9% vs 14 ± 9% of LV, respectively, P = 0.646). In 68 patients without MVO, T1-mapping based ECV of infarct region was comparable across Trevasc-CMR tertiles (P = 0.470).ConclusionIn STEMI patients, T2 values of infarct and remote myocardium increase with increasing CMR time after revascularization. However, these changes do not give rise to substantial variation of T2-mapping-derived AAR size nor of other CMR-based parameters of I/R.Trial registrationISRCTN03522116. Registered 30.4.2018 (retrospectively registered).
Highlights
To investigate the influence of cardiovascular magnetic resonance (CMR) timing after reperfusion on CMR-derived parameters of ischemia/reperfusion (I/R) injury in patients with ST-segment elevation myocardial infarction (STEMI)
Study population Among the 195 patients evaluated for study eligibility, 9 patients did not undergo CMR because of claustrophobia or refusal of the exam
Twenty-three patients were excluded after CMR because of time-to-reperfusion exceeded 12 h from symptoms onset, previous myocardial infarction / coronary revascularitation or insufficient late gadolinium enhancement (LGE) quality
Summary
To investigate the influence of cardiovascular magnetic resonance (CMR) timing after reperfusion on CMR-derived parameters of ischemia/reperfusion (I/R) injury in patients with ST-segment elevation myocardial infarction (STEMI). Cardioprotection after primary percutaneous coronary intervention (PPCI) involves therapy which reduced myocardial damage due to ischemia/reperfusion (I/R), with the aim of minimizing infarct size in patients with ST-segment elevation myocardial infarction (STEMI) [1] This field is rapidly expanding and relies heavily on non-invasive imaging-based quantitative metrics of ischemic myocardial damage. Recent studies have cast doubts about the reliability of these parameters when CMR is carried out early after reperfusion [5,6,7,8,9,10,11,12] They underpinned that infarct-related myocardial edema features a highly dynamic course after reperfusion rising concerns about the optimal timing of CMR. The above studies relied largely on T2-weighted CMR for AAR quantification, which is less accurate, precise and robust than novel mapping techniques for edema quantification [14, 15]
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