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  • Oral presentation
  • Open Access

Prognostic significance of infarct core pathology in ST-elevation myocardial infarction survivors revealed by quantitative T2-weighted cardiac magnetic resonance

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Journal of Cardiovascular Magnetic Resonance201517 (Suppl 1) :O54

https://doi.org/10.1186/1532-429X-17-S1-O54

  • Published:

Keywords

  • Cardiac Magnetic Resonance
  • Late Gadolinium Enhancement
  • STEMI Patient
  • Microvascular Obstruction
  • Heart Failure Hospitalization

Background

Myocardial transverse relaxation time (T2, ms) is a fundamental magnetic property of tissue that is related to water content and mobility. The pathophysiological and prognostic importance of native myocardial T2 in acute ST-elevation myocardial infarction (STEMI) patients is unknown. We aimed to assess the clinical significance of native T2 within the infarct core using cardiac magnetic resonance (CMR) imaging.

Methods

We performed a prospective single center cohort study in reperfused STEMI patients who underwent CMR 2 days and 6 months post-MI. T2-weighted CMR (investigational prototype T2-prepared TrueFisp sequence) was measured in myocardial regions-of-interest. The infarct territory and microvascular obstruction were depicted with late gadolinium enhancement CMR. All-cause death or heart failure hospitalization was a pre-specified outcome that was assessed during follow-up.

Results

324 STEMI patients (mean±SD age 59±12 years, 237 males, 121 with anterior STEMI) gave informed consent and had CMR (14 July 2011 - 22 November 2012). All 324 had follow-up assessments (median duration 860 days). Infarct size was 18 ±14% of LV mass. One hundred and sixty four (51%) patients had late microvascular obstruction whereas 197 (61%) patients had an infarct core revealed by native T2. Native T2 within the infarct core (53.9±4.8) was higher than in the remote zone (49.7±2.1 ms; p<0.01) but lower than in the area-at-risk (62.9±5.1 ms) (p<0.01). In multivariable linear regression, native T2 in the infarct core was negatively associated with heart rate, Killip class, and peak neutrophil count at presentation (all p<0.05).

Baseline T2 core (ms) was univariably associated with LVEF (0.31 (0.04, 0.58); p=0.023). Baseline T2 core was not associated with LVEF or volumes at 6 months.

Thirty (10.4%) patients died or experienced a heart failure event. These events included 5 cardiovascular deaths, 3 non-cardiovascular deaths and 22 episodes of heart failure (Killip Class 3 or 4 heart failure (n=20) or defibrillator implantation n=2). T2-core (ms) was associated with all-cause death or heart failure hospitalization (hazard ratio 0.786, 95% CI 0.658, 0.939; p=0.008) including after adjustment for LVEF at baseline (p=0.017) or LV end-diastolic volume at baseline (p=0.009).

Conclusions

Infarct core revealed by native T2 was common and independently associated with all-cause death or heart failure hospitalization post-discharge.

Funding

N/A.
Figure 1
Figure 1

Kaplan-Meier survival curves grouped according to baseline infarct core T2 (lowest T2 tertile vs.tertiles 2 and 3) and all-cause death or heart failure (n=39) from and including the index admission to the end of follow-up (censor time 839 (598 to 1099) days).

Authors’ Affiliations

(1)
Golden Jubilee National Hospital, Clydebank, UK
(2)
Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
(3)
Robertson Center for Biostatistics, University of Glasgow, Glasgow, UK

Copyright

© Carrick et al; licensee BioMed Central Ltd. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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