Pathophysiology of LV Remodeling in Survivors of STEMI: Inflammation, Remote Myocardium, and Prognosis

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

Abstract

Objectives: The aim of this study was to investigate the clinical significance of native T1 values in remote myocardium in survivors of acute ST-segment elevation myocardial infarction (STEMI).

Background: The pathophysiology and prognostic significance of remote myocardium in the natural history of STEMI is uncertain. Cardiac magnetic resonance (CMR) reveals myocardial function and pathology. Native T1 (relaxation time in ms) is a fundamental magnetic resonance tissue property determined by water content and cellularity.

Results: A total of 300 STEMI patients (mean age 59 years; 74% male) gave informed consent. A total of 288 STEMI patients had evaluable native T1 CMR, and 267 patients (91%) had follow-up CMR at 6 months. Health outcome information was obtained for all of the participants (median follow-up 845 days). Infarct size was 18 ± 13% of left ventricular (LV) mass. Two days post-STEMI, native T1 was lower in remote myocardium than in the infarct zone (961 ± 25 ms vs. 1,097 ± 52 ms; p < 0.01). In multivariable regression, incomplete ST-segment resolution was associated with myocardial remote zone native T1 (regression coefficient 9.42; 95% confidence interval [CI]: 2.37 to 16.47; p = 0.009), as were the log of the admission C-reactive protein concentration (3.01; 95% CI: 0.016 to 5.85; p = 0.038) and the peak monocyte count (10.20; 95% CI: 0.74 to 19.67; p = 0.035). Remote T1 at baseline was associated with log N-terminal pro-B-type natriuretic peptide at 6 months (0.01; 95% CI: 0.00 to 0.02; p = 0.002; n = 151) and the change in LV end-diastolic volume from baseline to 6 months (0.13; 95% CI: 0.01 to 0.24; p = 0.035). Remote zone native T1 was independently associated with post-discharge major adverse cardiac events (n = 20 events; hazard ratio: 1.016; 95% CI: 1.000 to 1.032; p = 0.048) and all-cause death or heart failure hospitalization (n = 30 events during admission and post-discharge; hazard ratio: 1.014; 95% CI: 1.000 to 1.028; p = 0.049).

Conclusions: Reperfusion injury and inflammation early post-MI was associated with remote zone T1, which in turn was independently associated with LV remodeling and adverse cardiac events post-STEMI. (Detection and Significance of Heart Injury in ST Elevation Myocardial Infarction [BHF MR-MI]; NCT02072850).

Keywords: cardiac magnetic resonance; inflammation; myocardial infarction; remodeling; reperfusion.

Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1
Figure 1
Two Patients With Anterior STEMI and Divergent Clinical Courses Both patients had similar clinical presentations, with acute anterior ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention. The yellow arrow indicates the location of the thrombotic occlusion of the (A) left anterior descending, and (B) obtuse marginal, branch of the left coronary artery. The history of each patient is described in the Online Appendix. MRI = magnetic resonance imaging.
Figure 2
Figure 2
Flow Diagram of the Cohort Study CMR = cardiac magnetic resonance; other abbreviation as in Figure 1.
Figure 3
Figure 3
Remote Zone Native T1 and NT-proBNP 6 Months Post-MI Remote zone native T1 (ms) at baseline was associated with N-terminal pro–B-type natriuretic peptide (NT-proBNP) (median [interquartile range]) after 6 months (n = 151 patients with ST-segment elevation myocardial infarction) (Online Appendix). MI = myocardial infarction.

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