Abstract 18852: Prognostic Significance of Remote Myocardium Alterations Assessed by Quantitative Non-Contrast T1 Mapping Cardiac Magnetic Resonance in ST-Elevation Myocardial Infarction
Introduction: The exact role and clinical relevance of remote myocardium native T1 mapping alterations assessed by cardiac magnetic resonance (CMR) after ST-elevation myocardial infarction (STEMI) remains to be defined.
Hypothesis: This study sought to assess the prognostic significance of remote zone native T1 alterations for the prediction of hard clinical events in a STEMI population treated by primary percutaneous coronary intervention (PPCI) and to compare it with conventional markers of infarct severity.
Methods: We included 255 consecutive STEMI patients reperfused by PPCI within 12 hours after symptom onset. CMR core laboratory analysis was performed to assess left ventricular (LV) function, standard infarct characteristics (infarct size, myocardial salvage, microvascular obstruction) and native T1 values of the remote, non-infarcted myocardium. The primary endpoint was a composite of death, reinfarction and new congestive heart failure within 6 months after index event (major adverse cardiac events, MACE).
Results: Patients with increased remote zone native T1 values (>1129 ms) had significantly larger infarcts (p=0.012), less myocardial salvage (p=0.002) and more pronounced LV dysfunction (p=0.011). In multivariable analysis, remote zone native T1 was independently associated with MACE after adjusting for clinical risk factors (p=0.001) or other CMR variables (p=0.007). Native T1 of remote myocardium provided incremental prognostic information above clinical risk factors, LV ejection fraction and other established markers of infarct severity including infarct size (all p<0.05).
Conclusion: In STEMI patients treated by PPCI, evaluation of remote zone alterations by quantitative non-contrast T1 mapping provides independent and incremental prognostic information in addition to clinical risk factors and traditional CMR outcome markers. Remote zone alterations may therefore represent a novel therapeutic target as well as a useful parameter for optimized risk-stratification in STEMI patients.
Author Disclosures: I. Eitel: None. S. Reinstadler: None. T. Stiermaier: None. G. Fuernau: None. S. de Waha: None. S. Desch: None. H. Thiele: None.
- © 2016 by American Heart Association, Inc.