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


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.


CONCLUSIONS
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. CLINICALTRIALS.
NCT02072850.
BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G128TA, UK West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK.
David
D
Carrick
Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK.
Caroline
C
Haig
BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G128TA, UK.
Sam
S
Rauhalammi
BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G128TA, UK.
Nadeem
N
Ahmed
BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G128TA, UK.
Ify
I
Mordi
BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G128TA, UK.
Margaret
M
McEntegart
BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G128TA, UK.
Mark C
MC
Petrie
BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G128TA, UK.
Hany
H
Eteiba
BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G128TA, UK.
Stuart
S
Hood
BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G128TA, UK West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK.
Stuart
S
Watkins
BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G128TA, UK.
Mitchell
M
Lindsay
BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G128TA, UK.
Ahmed
A
Mahrous
Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK.
Ian
I
Ford
BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G128TA, UK West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK.
Niko
N
Tzemos
BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G128TA, UK.
Naveed
N
Sattar
BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G128TA, UK.
Paul
P
Welsh
BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G128TA, UK.
Aleksandra
A
Radjenovic
BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G128TA, UK.
Keith G
KG
Oldroyd
BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G128TA, UK West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK colin.berry@glasgow.ac.uk.
Colin
C
Berry
D015415:Biomarkers / Q000378:metabolism; D002306:Cardiac Volume; D054059:Coronary Occlusion / Q000401:mortality / Q000473:pathology / Q000628:therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D018810:Magnetic Resonance Angiography; D008297:Male; D055806:Microvessels; D008875:Middle Aged; D015425:Myocardial Reperfusion / Q000379:methods / Q000401:mortality; D062645:Percutaneous Coronary Intervention / Q000379:methods / Q000401:mortality; D011446:Prospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome; D020257:Ventricular Remodeling / Q000502:physiology
D015415:Biomarkers
Adverse remodelling; Cardiac magnetic resonance; Percutaneous coronary intervention; ST-elevation myocardial infarction