Persistent iron within the infarct core after ST-segment elevation myocardial infarction: implications for left ventricular remodeling and health outcomes

Carberry, J. et al. (2017) Persistent iron within the infarct core after ST-segment elevation myocardial infarction: implications for left ventricular remodeling and health outcomes. JACC: Cardiovascular Imaging, (doi:10.1016/j.jcmg.2017.08.027) (PMID:29153575) (Early Online Publication)

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Abstract

Objectives: This study sought to determine the incidence and prognostic significance of persistent iron in patients post–ST-segment elevation myocardial infarction (STEMI). Background: The clinical significance of persistent iron within the infarct core after STEMI complicated by acute myocardial hemorrhage is poorly understood. Methods: Patients who sustained an acute STEMI were enrolled in a cohort study (BHF MR-MI [Detection and Significance of Heart Injury in ST Elevation Myocardial Infarction]). Cardiac magnetic resonance imaging including T2* (observed time constant for the decay of transverse magnetization seen with gradient-echo sequences) mapping was performed at 2 days and 6 months post-STEMI. Myocardial hemorrhage or iron was defined as a hypointense infarct core with T2* signal <20 ms. Results: A total of 203 patients (age 57 ± 11 years, n = 158 [78%] male) had evaluable T2* maps at 2 days and 6 months post-STEMI; 74 (36%) patients had myocardial hemorrhage at baseline, and 44 (59%) of these patients had persistent iron at 6 months. Clinical associates of persistent iron included heart rate (p = 0.009), the absence of a history of hypertension (p = 0.017), and infarct size (p = 0.028). The presence of persistent iron was associated with worsening left ventricular (LV) end-diastolic volume (regression coefficient: 21.10; 95% confidence interval [CI]: 10.92 to 31.27; p < 0.001) and worsening LV ejection fraction (regression coefficient: −6.47; 95% CI: −9.22 to −3.72; p < 0.001). Persistent iron was associated with the subsequent occurrence of all-cause death or heart failure (hazard ratio: 3.91; 95% CI: 1.37 to 11.14; p = 0.011) and major adverse cardiac events (hazard ratio: 3.24; 95% CI: 1.09 to 9.64; p = 0.035) (median follow-up duration 1,457 days [range 233 to 1,734 days]). Conclusions: Persistent iron at 6 months post-STEMI is associated with worse LV and longer-term health outcomes. (Detection and Significance of Heart Injury in ST Elevation Myocardial Infarction [BHF MR-MI]; NCT02072850)

Item Type:Articles
Keywords:Magnetic resonance imaging, myocardial infarction, remodeling.
Status:Early Online Publication
Refereed:Yes
Glasgow Author(s) Enlighten ID:Welsh, Dr Paul and Carrick, Dr David and Petrie, Professor Mark and Oldroyd, Dr Keith and Carberry, Miss Jaclyn and Ford, Professor Ian and Hood, Dr Stuart and Berry, Professor Colin and Eteiba, Dr Hany and Haig, Dr Caroline and Sattar, Professor Naveed and Mordi, Dr Ify and Radjenovic, Dr Aleksandra
Authors: Carberry, J., Carrick, D., Haig, C., Ahmed, N., Mordi, I., McEntegart, M., Petrie, M. C., Eteiba, H., Hood, S., Watkins, S., Lindsay, M., Davie, A., Mahrous, A., Ford, I., 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:JACC: Cardiovascular Imaging
Publisher:Elsevier
ISSN:1936-878X
ISSN (Online):1876-7591
Published Online:15 November 2017
Copyright Holders:Copyright © 2017 The Authors
First Published:First published in JACC: Cardiovascular Imaging 2017
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
617771BHF centre of excellenceRhian TouyzBritish Heart Foundation (BHF)RE/13/5/30177RI CARDIOVASCULAR & MEDICAL SCIENCES
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