Remote Zone Extracellular Volume and Left Ventricular Remodeling in Survivors of ST-Elevation Myocardial Infarction

Jaclyn Carberry, David Carrick, Caroline Haig, Samuli M Rauhalammi, Nadeem Ahmed, Ify Mordi, Margaret McEntegart, Mark C Petrie, Hany Eteiba, Stuart Hood, Stuart Watkins, Mitchell Lindsay, Andrew Davie, Ahmed Mahrous, Ian Ford, Naveed Sattar, Paul Welsh, Aleksandra Radjenovic, Keith G Oldroyd, Colin Berry, Jaclyn Carberry, David Carrick, Caroline Haig, Samuli M Rauhalammi, Nadeem Ahmed, Ify Mordi, Margaret McEntegart, Mark C Petrie, Hany Eteiba, Stuart Hood, Stuart Watkins, Mitchell Lindsay, Andrew Davie, Ahmed Mahrous, Ian Ford, Naveed Sattar, Paul Welsh, Aleksandra Radjenovic, Keith G Oldroyd, Colin Berry

Abstract

The natural history and pathophysiological significance of tissue remodeling in the myocardial remote zone after acute ST-elevation myocardial infarction (STEMI) is incompletely understood. Extracellular volume (ECV) in myocardial regions of interest can now be measured with cardiac magnetic resonance imaging. Patients who sustained an acute STEMI were enrolled in a cohort study (BHF MR-MI [British Heart Foundation Magnetic Resonance Imaging in Acute ST-Segment Elevation Myocardial Infarction study]). Cardiac magnetic resonance was performed at 1.5 Tesla at 2 days and 6 months post STEMI. T1 modified Look-Locker inversion recovery mapping was performed before and 15 minutes after contrast (0.15 mmol/kg gadoterate meglumine) in 140 patients at 2 days post STEMI (mean age: 59 years, 76% male) and in 131 patients at 6 months post STEMI. Remote zone ECV was lower than infarct zone ECV (25.6±2.8% versus 51.4±8.9%; P<0.001). In multivariable regression, left ventricular ejection fraction was inversely associated with remote zone ECV (P<0.001), and diabetes mellitus was positively associated with remote zone ECV (P=0.010). No ST-segment resolution (P=0.034) and extent of ischemic area at risk (P<0.001) were multivariable associates of the change in remote zone ECV at 6 months (ΔECV). ΔECV was a multivariable associate of the change in left ventricular end-diastolic volume at 6 months (regression coefficient [95% confidence interval]: 1.43 (0.10-2.76); P=0.036). ΔECV is implicated in the pathophysiology of left ventricular remodeling post STEMI, but because the effect size is small, ΔECV has limited use as a clinical biomarker of remodeling.

Clinical trial registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02072850.

Keywords: edema; extracellular matrix; magnetic resonance imaging; myocardial infarction; myocardium.

© 2016 The Authors.

Figures

Figure 1.
Figure 1.
Two patients with similar presentations of acute ST-elevation myocardial infarction (STEMI). Both patients were treated by primary percutaneous coronary intervention and with the same medication. At the end of the procedure, both patients had thrombolysis in myocardial infarction coronary flow grade 3 in the culprit artery. A, Increasing remote zone extracellular volume (ECV). Cardiac magnetic resonance (CMR) performed 2 days post STEMI revealed a remote zone ECV of 28%. Remote zone ECV increased by 4% by 6 months to 32%. Left ventricular (LV) end-diastolic volume increased from 116 to 135 mL as measured by the 2-day and 6-month CMR scans. B, Decreasing remote zone ECV: CMR performed 2 days post STEMI revealed a remote zone ECV of 22%. Remote zone ECV decreased by 2% by 6 months to 20%. LV end-diastolic volume decreased from 128 to 102 mL as measured by the 2-day and 6-month CMR scans. MRI indicates magnetic resonance imaging.
Figure 2.
Figure 2.
Remote zone extracellular volume (ECV) at baseline versus change in remote zone ECV at follow-up.

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