title: Identification of the potentially arrhythmogenic substrate in the acute phase of ST-segment elevation myocardial infarction.
abstract: Predicting sudden cardiac death risk in the first months after ST-segment elevation myocardial infarction (STEMI) remains challenging.
  
  
  
  The purpose of this study was to investigate the ability of late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) to identify the potentially arrhythmogenic substrate and its temporal evolution after STEMI.
  
  
  
  One hundred consecutive patients with a first STEMI were included. Three-dimensional high-resolution LGE-CMR was obtained at 3 T on days 7 and 180. Left ventricular wall was segmented and characterized by pixel signal intensity algorithm in 5 layers from endocardium to epicardium. A 3-dimensional color-coded shell map was obtained for each layer, depicting scar core and border zone (BZ) distribution. Presence and characteristics of BZ channels were registered for each layer.
  
  
  
  At 180 days, left ventricular ejection fraction had improved significantly (from 46.7% ± 10% to 51.5% ± 10%; P <.001) and scar mass was reduced (from 22.6 ± 20 g to 13.8 ± 12 g; P <.001). Most BZ channels (89%) were identified in the same myocardial layer and American Heart Association (AHA) segment, with the same orientation and morphology in both studies. Early LGE-CMR had 96% sensitivity and 90% specificity for predicting presence of BZ channels at 180 days. Greater presence was observed in patients with no-reflow phenomenon at baseline (P = .01).
  
  
  
  Most BZ channels can be identified by LGE-CMR at day 7 post-STEMI and, despite scar mass reduction, remain unaltered at 6 months, suggesting that the potentially arrhythmogenic substrate is established within the first week post-STEMI.
authors.affiliation: Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain.
authors.forename: Diego
authors.initials: D
authors.lastname: Penela
authors.affiliation: Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Acosta
authors.affiliation: Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Andreu
authors.affiliation: Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain.
authors.forename: Jose T
authors.initials: JT
authors.lastname: Ortiz-Perez
authors.affiliation: Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Bosch
authors.affiliation: Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain.
authors.forename: Rosario J
authors.initials: RJ
authors.lastname: Perea
authors.affiliation: Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain.
authors.forename: Teresa M
authors.initials: TM
authors.lastname: de Caralt
authors.affiliation: Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Fernández-Armenta
authors.affiliation: Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Soto-Iglesias
authors.affiliation: Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain.
authors.forename: Susana
authors.initials: S
authors.lastname: Prat-Gonzalez
authors.affiliation: Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain.
authors.forename: Roger
authors.initials: R
authors.lastname: Borràs
authors.affiliation: Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain.
authors.forename: Lluis
authors.initials: L
authors.lastname: Mont
authors.affiliation: Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Hervas
authors.affiliation: Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Morales-Ruiz
authors.affiliation: Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain.
authors.forename: Wladimiro
authors.initials: W
authors.lastname: Jiménez
authors.affiliation: Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain.
authors.forename: Aurea
authors.initials: A
authors.lastname: Mira
authors.affiliation: Siemens Healthcare Tarrytown, New York, USA.
authors.forename: Jim
authors.initials: J
authors.lastname: Donnelly
authors.affiliation: Siemens Healthcare Tarrytown, New York, USA.
authors.forename: Okan
authors.initials: O
authors.lastname: Ekinci
authors.affiliation: Siemens Healthcare Tarrytown, New York, USA.
authors.forename: Luis
authors.initials: L
authors.lastname: Lasalvia
authors.affiliation: Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain,. Electronic address: berruezo@clinic.ub.es.
authors.forename: Antonio
authors.initials: A
authors.lastname: Berruezo
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D002921:Cicatrix / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D003287:Contrast Media / Q000494:pharmacology; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control; D005260:Female; D005682:Gadolinium / Q000494:pharmacology; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D000072657:ST Elevation Myocardial Infarction / Q000150:complications*; D013223:Statistics as Topic; D016277:Ventricular Function, Left
chemical_list: D003287:Contrast Media; D005682:Gadolinium
keywords: Arrhythmogenic substrate; Border zone channels; Cardiac magnetic resonance; Myocardial infarction; Sudden cardiac death