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Objectives <p>The aim of this study was to investigate the prognostic relevance of remote myocardium alterations assessed by cardiac magnetic resonance (CMR) T1 mapping (native T1 and extracellular volume (ECV)) in patients after ST-segment elevation myocardial infarction (STEMI).</p> Materials and methods <p>This retrospective study analyzed STEMI patients treated with primary percutaneous coronary intervention (PCI) who were included in the prospective MARINA-STEMI study. CMR images were analyzed for left ventricular (LV) function, standard infarct characteristics, as well as native remote T1 and remote ECV. The primary clinical endpoint was the composite of all-cause mortality, re-infarction and new congestive heart failure (Major adverse cardiac events (MACE)).</p> Results <p>Four hundred ninety-one patients (median age 58 [Interquartile range (IQR): 52–66 years], 91 (19%) female) patients underwent CMR imaging at 4 ([IQR: 3–5]) days after PCI. Over a median follow-up of 12 months ([IQR: 12–13]) after STEMI, 42 MACE outcomes occurred. Higher native remote T1-times (1018.5 [IQR: 997.0–1064.0] ms vs. 1007.0 [IQR: 977.0–1041.5] ms, <i>p</i> = 0.033) as well as higher remote ECV values (28.07 vs. 26.27%, <i>p</i> = 0.009) were observed in patients with MACE. Multivariable Cox-regression analysis demonstrated that remote ECV (hazard ratio (HR): 1.53 [confidence interval (CI): 1.07–2.19], <i>p</i> = 0.020) but not native remote T1 is independently associated with MACE.</p> Conclusions <p>A comprehensive assessment of the remote myocardium with native T1 and ECV provides prognostic information in a contemporary cohort of low-risk STEMI patients. Remote ECV, but not remote native T1, was found to be an independent predictor of MACE.</p> Key Points <p><Emphasis Type="BoldItalic">Question</Emphasis> <i>The prognostic implications of remote myocardium changes assessed by cardiac magnetic resonance (CMR) T1 mapping in patients after ST-segment elevation myocardial infarction (STEMI) are not fully understood.</i></p> <p><Emphasis Type="BoldItalic">Findings</Emphasis> <i>After STEMI, for patients treated with primary percutaneous coronary intervention, remote extracellular volume (ECV) was found to be an independent predictor of major adverse cardiac events.</i></p> <p><Emphasis Type="BoldItalic">Clinical relevance</Emphasis> <i>This study underlines the importance of remote myocardium characterization as a promising diagnostic tool. In particular, the quantification of ECV changes in the remote myocardium could be relevant for optimized CMR-imaging-based risk stratification in patients after STEMI.</i></p> Graphical Abstract <p></p>

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Prognostic impact of remote myocardium changes using T1 mapping in patients with ST-segment elevation myocardial infarction

  • 期刊论文

  • 发表日期：

    2025年6月4日

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  • Fritz Oberhollenzer,
  • Ivan Lechner,
  • Martin Reindl,
  • Christina Tiller,
  • Magdalena Holzknecht,
  • Franziska Roithinger,
  • Can Gollmann-Tepeköylü,
  • Agnes Mayr,
  • Axel Bauer,
  • Bernhard Metzler,
  • Sebastian J. Reinstadler

摘要

Objectives

The aim of this study was to investigate the prognostic relevance of remote myocardium alterations assessed by cardiac magnetic resonance (CMR) T1 mapping (native T1 and extracellular volume (ECV)) in patients after ST-segment elevation myocardial infarction (STEMI).

Materials and methods

This retrospective study analyzed STEMI patients treated with primary percutaneous coronary intervention (PCI) who were included in the prospective MARINA-STEMI study. CMR images were analyzed for left ventricular (LV) function, standard infarct characteristics, as well as native remote T1 and remote ECV. The primary clinical endpoint was the composite of all-cause mortality, re-infarction and new congestive heart failure (Major adverse cardiac events (MACE)).

Results

Four hundred ninety-one patients (median age 58 [Interquartile range (IQR): 52–66 years], 91 (19%) female) patients underwent CMR imaging at 4 ([IQR: 3–5]) days after PCI. Over a median follow-up of 12 months ([IQR: 12–13]) after STEMI, 42 MACE outcomes occurred. Higher native remote T1-times (1018.5 [IQR: 997.0–1064.0] ms vs. 1007.0 [IQR: 977.0–1041.5] ms, p = 0.033) as well as higher remote ECV values (28.07 vs. 26.27%, p = 0.009) were observed in patients with MACE. Multivariable Cox-regression analysis demonstrated that remote ECV (hazard ratio (HR): 1.53 [confidence interval (CI): 1.07–2.19], p = 0.020) but not native remote T1 is independently associated with MACE.

Conclusions

A comprehensive assessment of the remote myocardium with native T1 and ECV provides prognostic information in a contemporary cohort of low-risk STEMI patients. Remote ECV, but not remote native T1, was found to be an independent predictor of MACE.

Key Points

Question The prognostic implications of remote myocardium changes assessed by cardiac magnetic resonance (CMR) T1 mapping in patients after ST-segment elevation myocardial infarction (STEMI) are not fully understood.

Findings After STEMI, for patients treated with primary percutaneous coronary intervention, remote extracellular volume (ECV) was found to be an independent predictor of major adverse cardiac events.

Clinical relevance This study underlines the importance of remote myocardium characterization as a promising diagnostic tool. In particular, the quantification of ECV changes in the remote myocardium could be relevant for optimized CMR-imaging-based risk stratification in patients after STEMI.

Graphical Abstract