Persistence of infarct zone T2 hyperintensity at 6 months after acute ST-elevation myocardial infarction: incidence, pathophysiology and prognostic implications

Carberry, J. et al. (2017) Persistence of infarct zone T2 hyperintensity at 6 months after acute ST-elevation myocardial infarction: incidence, pathophysiology and prognostic implications. Circulation: Cardiovascular Imaging, 10(12), e006586. (PMID:29242240) (PMCID:PMC5753833)

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Abstract

Background—The incidence and clinical significance of persistent T2 hyperintensity after acute ST-segment–elevation myocardial infarction (STEMI) is uncertain. Methods and Results—Patients who sustained an acute STEMI were enrolled in a cohort study (BHF MR-MI: NCT02072850). Two hundred eighty-three STEMI patients (mean age, 59±12 years; 75% male) had cardiac magnetic resonance with T2 mapping performed at 2 days and 6 months post-STEMI. Persisting T2 hyperintensity was defined as infarct T2 >2 SDs from remote T2 at 6 months. Infarct zone T2 was higher than remote zone T2 at 2 days (66.3±6.1 versus 49.7±2.1 ms; P<0.001) and 6 months (56.8±4.5 versus 49.7±2.3 ms; P<0.001). Remote zone T2 did not change over time (mean change, 0.0±2.7 ms; P=0.837), whereas infarct zone T2 decreased (−9.5±6.4 ms; P<0.001). At 6 months, T2 hyperintensity persisted in 189 (67%) patients, who were more likely to have Thrombus in Myocardial Infarction flow 0 or 1 in the culprit artery (P=0.020), incomplete ST-segment resolution (P=0.037), and higher troponin (P=0.024). Persistent T2 hyperintensity was associated with NT-proBNP (N-terminal pro-B-type natriuretic peptide) concentration (0.57 on a log scale [0.42–0.72]; P=0.004) and the likelihood of adverse left ventricular remodeling (>20% change in left ventricular end-diastolic volume; 21.91 [2.75–174.29]; P=0.004). Persistent T2 hyperintensity was associated with all-cause death and heart failure, but the result was not significant (P=0.051). ΔT2 was associated with all-cause death and heart failure (P=0.004) and major adverse cardiac events (P=0.013). Conclusions—Persistent T2 hyperintensity occurs in two thirds of STEMI patients. Persistent T2 hyperintensity was associated with the initial STEMI severity, adverse remodeling, and long-term health outcome. Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier: NCT02072850.

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 Eteiba, Dr Hany and Oldroyd, Dr Keith and Carberry, Miss Jaclyn and Haig, Dr Caroline and Sattar, Professor Naveed and Ford, Professor Ian and Mordi, Dr Ify and Ahmed, Mr Nadeem and Hood, Dr Stuart
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:Circulation: Cardiovascular Imaging
Publisher:American Heart Assocation
ISSN:1941-9651
ISSN (Online):1942-0080
Published Online:14 December 2017
Copyright Holders:Copyright © 2017 The Authors
First Published:First published in Circulation: Cardiovascular Imaging 10(12):e006586
Publisher Policy:Reproduced under a Creative Commons License

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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