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

Carrick, D. et al. (2016) Prognostic significance of infarct core pathology revealed by quantitative non-contrast in comparison to contrast cardiac magnetic resonance imaging in reperfused ST-elevation myocardial infarction survivors. European Heart Journal, 37(13), pp. 1044-1059. (doi:10.1093/eurheartj/ehv372) (PMID:26261290) (PMCID:PMC4816961)

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Abstract

Aims To 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 results We 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. Conclusion Infarct core native T1 represents a novel non-contrast CMR biomarker with potential for infarct characterization and prognostication in STEMI survivors. Confirmatory studies are warranted.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Berry, Professor Colin and Welsh, Dr Paul 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 Sattar, Professor Naveed and Ford, Professor Ian and Mordi, Dr Ify and Radjenovic, Dr Aleksandra and Ahmed, Mr Nadeem and Hood, Dr Stuart
Authors: Carrick, D., Haig, C., Rauhalammi, S., Ahmed, N., Mordi, I., McEntegart, M., Petrie, M. C., Eteiba, H., Hood, S., Lindsay, M., Mahrous, A., Ford, I., Tzemos, N., Sattar, N., Welsh, P., Radjenovic, A., Oldroyd, K. G., 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
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:European Heart Journal
Journal Abbr.:Eur. heart j.
Publisher:Oxford University Press
ISSN:0195-668X
ISSN (Online):1522-9645
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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
544551Validation and significance of myocardial haemorrhage revealed by "bright blood" T2-weighted MRI in heart attack survivors: a prospective cohort study.Colin BerryBritish Heart Foundation (BHF)PG/11/2/28474RI CARDIOVASCULAR & MEDICAL SCIENCES
612031Cardiac biomarkers and CVD risk screening: a cost-effective public health measure?Paul WelshBritish Heart Foundation (BHF)FS/12/62/29889RI CARDIOVASCULAR & MEDICAL SCIENCES