title: Automated Extracellular Volume Fraction Mapping Provides Insights Into the Pathophysiology of Left Ventricular Remodeling Post-Reperfused ST-Elevation Myocardial Infarction.
abstract: Whether the remote myocardium of reperfused ST-segment elevation myocardial infarction (STEMI) patients plays a part in adverse left ventricular (LV) remodeling remains unclear. We aimed to use automated extracellular volume fraction (ECV) mapping to investigate whether changes in the ECV of the remote (ECVR emote) and infarcted myocardium (ECVI nfarct) impacted LV remodeling.
  
  
  
  Forty-eight of 50 prospectively recruited reperfused STEMI patients completed a cardiovascular magnetic resonance at 4±2 days and 40 had a follow-up scan at 5±2 months. Twenty healthy volunteers served as controls. Mean segmental values for native T1, T2, and ECV were obtained. Adverse LV remodeling was defined as ≥20% increase in LV end-diastolic volume. ECVR emote was higher on the acute scan when compared to control (27.9±2.1% vs 26.4±2.1%; P=0.01). Eight patients developed adverse LV remodeling and had higher ECVR emote acutely (29.5±1.4% vs 27.4±2.0%; P=0.01) and remained higher at follow-up (28.6±1.5% vs 26.6±2.1%; P=0.02) compared to those without. Patients with a higher ECVR emote and a lower myocardial salvage index (MSI) acutely were significantly associated with adverse LV remodeling, independent of T1Remote, T1Core and microvascular obstruction, whereas a higher ECVI nfarct was significantly associated with worse wall motion recovery.
  
  
  
  ECVR emote was increased acutely in reperfused STEMI patients. Those with adverse LV remodeling had higher ECVR emote acutely, and this remained higher at follow-up than those without adverse LV remodeling. A higher ECVR emote and a lower MSI acutely were significantly associated with adverse LV remodeling whereas segments with higher ECVI nfarct were less likely to recover wall motion.
authors.affiliation: The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, London, United Kingdom The National Institute of Health Research University College London Hospitals Biomedical Research Center, London, United Kingdom Barts Heart Center, St Bartholomew's Hospital, London, United Kingdom.
authors.forename: Heerajnarain
authors.initials: H
authors.lastname: Bulluck
authors.affiliation: Barts Heart Center, St Bartholomew's Hospital, London, United Kingdom.
authors.forename: Stefania
authors.initials: S
authors.lastname: Rosmini
authors.affiliation: Barts Heart Center, St Bartholomew's Hospital, London, United Kingdom.
authors.forename: Amna
authors.initials: A
authors.lastname: Abdel-Gadir
authors.affiliation: The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, London, United Kingdom The National Institute of Health Research University College London Hospitals Biomedical Research Center, London, United Kingdom Barts Heart Center, St Bartholomew's Hospital, London, United Kingdom.
authors.forename: Steven K
authors.initials: SK
authors.lastname: White
authors.affiliation: Barts Heart Center, St Bartholomew's Hospital, London, United Kingdom.
authors.forename: Anish N
authors.initials: AN
authors.lastname: Bhuva
authors.affiliation: Barts Heart Center, St Bartholomew's Hospital, London, United Kingdom.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Treibel
authors.affiliation: Barts Heart Center, St Bartholomew's Hospital, London, United Kingdom.
authors.forename: Marianna
authors.initials: M
authors.lastname: Fontana
authors.affiliation: Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Gonzalez-Lopez
authors.affiliation: CHU de Bordeaux, University of Bordeaux, France.
authors.forename: Patricia
authors.initials: P
authors.lastname: Reant
authors.affiliation: The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, London, United Kingdom The National Institute of Health Research University College London Hospitals Biomedical Research Center, London, United Kingdom Barts Heart Center, St Bartholomew's Hospital, London, United Kingdom.
authors.forename: Manish
authors.initials: M
authors.lastname: Ramlall
authors.affiliation: The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, London, United Kingdom The National Institute of Health Research University College London Hospitals Biomedical Research Center, London, United Kingdom Barts Heart Center, St Bartholomew's Hospital, London, United Kingdom.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Hamarneh
authors.affiliation: The National Institute of Health Research University College London Hospitals Biomedical Research Center, London, United Kingdom Barts Heart Center, St Bartholomew's Hospital, London, United Kingdom.
authors.forename: Alex
authors.initials: A
authors.lastname: Sirker
authors.affiliation: Barts Heart Center, St Bartholomew's Hospital, London, United Kingdom.
authors.forename: Anna S
authors.initials: AS
authors.lastname: Herrey
authors.affiliation: Barts Heart Center, St Bartholomew's Hospital, London, United Kingdom.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Manisty
authors.affiliation: The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, London, United Kingdom The National Institute of Health Research University College London Hospitals Biomedical Research Center, London, United Kingdom.
authors.forename: Derek M
authors.initials: DM
authors.lastname: Yellon
authors.affiliation: National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD.
authors.forename: Peter
authors.initials: P
authors.lastname: Kellman
authors.affiliation: The National Institute of Health Research University College London Hospitals Biomedical Research Center, London, United Kingdom Barts Heart Center, St Bartholomew's Hospital, London, United Kingdom.
authors.forename: James C
authors.initials: JC
authors.lastname: Moon
authors.affiliation: The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, London, United Kingdom The National Institute of Health Research University College London Hospitals Biomedical Research Center, London, United Kingdom Barts Heart Center, St Bartholomew's Hospital, London, United Kingdom Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore National Heart Research Institute Singapore, National Heart Center Singapore, Singapore derek.hausenloy@duke-nus.edu.sg.
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Hausenloy
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D005109:Extracellular Matrix / Q000378:metabolism*; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D008279:Magnetic Resonance Imaging; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D020257:Ventricular Remodeling / Q000502:physiology*
keywords: ST‐segment elevation myocardial infarction; T1 mapping; T2 mapping; extracellular volume fraction; left ventricular remodeling