Pathophysiology of LV remodeling in survivors of STEMI : inflammation, remote myocardium, and prognosis

Carrick, D. et al. (2015) Pathophysiology of LV remodeling in survivors of STEMI : inflammation, remote myocardium, and prognosis. JACC: Cardiovascular Imaging, 8(7), pp. 779-789. (doi: 10.1016/j.jcmg.2015.03.007) (PMID:26093923) (PMCID:PMC4509710)

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Objectives: The aim of this study was to investigate the clinical significance of native T1 values in remote myocardium in survivors of acute ST-segment elevation myocardial infarction (STEMI). Background: The pathophysiology and prognostic significance of remote myocardium in the natural history of STEMI is uncertain. Cardiac magnetic resonance (CMR) reveals myocardial function and pathology. Native T1 (relaxation time in ms) is a fundamental magnetic resonance tissue property determined by water content and cellularity. Results: A total of 300 STEMI patients (mean age 59 years; 74% male) gave informed consent. A total of 288 STEMI patients had evaluable native T1 CMR, and 267 patients (91%) had follow-up CMR at 6 months. Health outcome information was obtained for all of the participants (median follow-up 845 days). Infarct size was 18 ± 13% of left ventricular (LV) mass. Two days post-STEMI, native T1 was lower in remote myocardium than in the infarct zone (961 ± 25 ms vs. 1,097 ± 52 ms; p < 0.01). In multivariable regression, incomplete ST-segment resolution was associated with myocardial remote zone native T1 (regression coefficient 9.42; 95% confidence interval [CI]: 2.37 to 16.47; p = 0.009), as were the log of the admission C-reactive protein concentration (3.01; 95% CI: 0.016 to 5.85; p = 0.038) and the peak monocyte count (10.20; 95% CI: 0.74 to 19.67; p = 0.035). Remote T1 at baseline was associated with log N-terminal pro–B-type natriuretic peptide at 6 months (0.01; 95% CI: 0.00 to 0.02; p = 0.002; n = 151) and the change in LV end-diastolic volume from baseline to 6 months (0.13; 95% CI: 0.01 to 0.24; p = 0.035). Remote zone native T1 was independently associated with post-discharge major adverse cardiac events (n = 20 events; hazard ratio: 1.016; 95% CI: 1.000 to 1.032; p = 0.048) and all-cause death or heart failure hospitalization (n = 30 events during admission and post-discharge; hazard ratio: 1.014; 95% CI: 1.000 to 1.028; p = 0.049). Conclusions: Reperfusion injury and inflammation early post-MI was associated with remote zone T1, which in turn was independently associated with LV remodeling and adverse cardiac events post-STEMI. (Detection and Significance of Heart Injury in ST Elevation Myocardial Infarction [BHF MR-MI]

Item Type:Articles
Glasgow Author(s) Enlighten ID:Berry, Professor Colin and Welsh, Professor Paul and Eteiba, Dr H and Carrick, Dr David and Petrie, Professor Mark and Rauhalammi, Mr Samuli 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 Hood, Dr Stuart and Ahmed, Mr Nadeem
Authors: Carrick, D., Haig, C., Rauhalammi, S., Ahmed, N., Mordi, I., McEntegart, M., Petrie, M., Eteiba, H., Lindsay, M., Watkins, S., Hood, S., Davie, A., Marous, A., Sattar, N., Welsh, P., Tzemos, N., Radjenovic, A., Ford, I., Oldroyd, K., and Berry, C.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
Journal Name:JACC: Cardiovascular Imaging
ISSN (Online):1876-7591
Copyright Holders:Copyright © 2015 The Authors
First Published:First published in JACC: Cardiovascular Imaging 8(7):779-789
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