Prognostic significance of infarct core pathology in ST-elevation myocardial infarction survivors revealed by quantitative T2-weighted cardiac magnetic resonance

Carrick, D. et al. (2015) Prognostic significance of infarct core pathology in ST-elevation myocardial infarction survivors revealed by quantitative T2-weighted cardiac magnetic resonance. Journal of Cardiovascular Magnetic Resonance, 17(Sup 1), O54. (doi:10.1186/1532-429X-17-S1-O54) (PMCID:PMC4328590)

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Abstract

Background: Myocardial transverse relaxation time (T2, ms) is a fundamental magnetic property of tissue that is related to water content and mobility. The pathophysiological and prognostic importance of native myocardial T2 in acute ST-elevation myocardial infarction (STEMI) patients is unknown. We aimed to assess the clinical significance of native T2 within the infarct core using cardiac magnetic resonance (CMR) imaging. Methods: We performed a prospective single center cohort study in reperfused STEMI patients who underwent CMR 2 days and 6 months post-MI. T2-weighted CMR (investigational prototype T2-prepared TrueFisp sequence) was measured in myocardial regions-of-interest. The infarct territory and microvascular obstruction were depicted with late gadolinium enhancement CMR. All-cause death or heart failure hospitalization was a pre-specified outcome that was assessed during follow-up. Results: 324 STEMI patients (mean±SD age 59±12 years, 237 males, 121 with anterior STEMI) gave informed consent and had CMR (14 July 2011 - 22 November 2012). All 324 had follow-up assessments (median duration 860 days). Infarct size was 18 ±14% of LV mass. One hundred and sixty four (51%) patients had late microvascular obstruction whereas 197 (61%) patients had an infarct core revealed by native T2. Native T2 within the infarct core (53.9±4.8) was higher than in the remote zone (49.7±2.1 ms; p<0.01) but lower than in the area-at-risk (62.9±5.1 ms) (p<0.01). In multivariable linear regression, native T2 in the infarct core was negatively associated with heart rate, Killip class, and peak neutrophil count at presentation (all p<0.05). Baseline T2 core (ms) was univariably associated with LVEF (0.31 (0.04, 0.58); p=0.023). Baseline T2 core was not associated with LVEF or volumes at 6 months. Thirty (10.4%) patients died or experienced a heart failure event. These events included 5 cardiovascular deaths, 3 non-cardiovascular deaths and 22 episodes of heart failure (Killip Class 3 or 4 heart failure (n=20) or defibrillator implantation n=2). T2-core (ms) was associated with all-cause death or heart failure hospitalization (hazard ratio 0.786, 95% CI 0.658, 0.939; p=0.008) including after adjustment for LVEF at baseline (p=0.017) or LV end-diastolic volume at baseline (p=0.009). Conclusions: Infarct core revealed by native T2 was common and independently associated with all-cause death or heart failure hospitalization post-discharge.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Berry, Professor Colin and Carrick, Dr David and Petrie, Professor Mark and Rauhalammi, Mr Samuli and Eteiba, Dr Hany and Oldroyd, Dr Keith and Tzemos, Dr Nikolaos and Haig, Dr Caroline and Ford, Professor Ian and Mordi, Dr Ify and Radjenovic, Dr Aleksandra and Hood, Dr Stuart
Authors: Carrick, D., Haig, C., Rauhalammi, S., Ahmed, N., Mordi, I., McEntegart, M., Petrie, M., Eteiba, H., Hood, S., Watkins, S., Lindsay, M., Marous, A., Radjenovic, A., Ford, I., Tzemos, N., Oldroyd, K., and Berry, C.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:Journal of Cardiovascular Magnetic Resonance
Publisher:BioMed Central
ISSN:1097-6647
ISSN (Online):1532-429X
Copyright Holders:Copyright © 2015 The Authors
First Published:First published in Journal of Cardiovascular Magnetic Resonance 17(Sup.1):O54
Publisher Policy:Reproduced under a Creative Commons License

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