European Radiology

, Volume 29, Issue 5, pp 2369–2377 | Cite as

Microvascular obstruction extent predicts major adverse cardiovascular events in patients with acute myocardial infarction and preserved ejection fraction

  • Nicola Galea
  • Gian Marco Dacquino
  • Rosa Maria Ammendola
  • Simona Coco
  • Luciano Agati
  • Laura De Luca
  • Iacopo Carbone
  • Francesco Fedele
  • Carlo Catalano
  • Marco FranconeEmail author



To investigate the prognostic role of early post-infarction cardiac magnetic resonance (CMR) on long-term risk stratification of ST segment elevation myocardial infarction (STEMI) patients with preserved left ventricular ejection fraction (LVEF).


Seventy-seven STEMI patients treated by primary percutaneous coronary intervention (PCI) and LVEF > 50% at CMR were included. The median time between STEMI and CMR was 5 days (IQR 2–8). LV volumes and function, area at risk (on T2 weighted images), infarcted myocardium (on late enhanced images), intramyocardial hemorrhage, and early and late microvascular obstruction (MVO) were detected and measured. CMR tissue determinants were correlated with the incidence of major adverse cardiovascular events (MACEs) over a 5-year follow-up.


During median follow-up of 4 years (range 3 to 5 years), eight (10%) patients experienced MACE, yielding an annualized event rate of 2.1%. All CMR tissue markers were not significantly different between MACE and no-MACE patients, except for the presence of late MVO (50% vs. 16%, respectively; p = 0.044) and its extent (2.30 ± 1.64 g vs. 0.18 ± 0.12 g, respectively; p = 0.000). From receiver-operating characteristic (ROC) curve (area under the curve 0.89; 95% confidence interval, 0.75–1.0; p = 0.000), late MVO extent > 0.385 g was a strong independent predictor of MACE at long-term follow-up (sensitivity = 87%, specificity = 90%; hazard ratio = 2.24; 95% confidence interval, 1.51–3.33; p = 0.000).


Late MVO extent after primary PCI on CMR seems to be a strong predictor of MACE at 5-year follow-up in patients with LVEF > 50%. Noticeably, late MVO extent > 0.385 g provided relevant prognostic insights leading to improved long-term risk stratification.

Key Points

Tissue markers provided by cardiac magnetic resonance aid in prognostic stratification after myocardial infarction

The occurrence of late microvascular obstruction after acute myocardial infarction increases risk of major adverse events at 5-year follow-up.

The greater microvascular obstruction extent on late gadolinium enhanced images is related to an increased risk of adverse events in patients with myocardial infarction and preserved left ventricular function.


Cardiac magnetic resonance Acute myocardial infarction Left ventricular ejection fraction Major adverse cardiovascular events Microvascular obstruction 



Area at risk


Angiotensin converting enzyme


Acute myocardial infarction


Angiotensin receptor blocker


Area under the curve


Coronary artery bypass graft


Cardiac magnetic resonance


End-diastolic volume


End-systolic volume


Heart failure


Heart failure with preserved ejection fraction


Interquartile range


Late gadolinium enhancement


Left ventricular ejection fraction


Left ventricular systolic dysfunction


Major adverse cardiovascular events


Microvascular obstruction


Non ST segment elevation myocardial infarction


Percutaneous coronary intervention


Receiver-operating characteristic


Right ventricle


ST segment elevation myocardial infarction


Short tau inversion recovery


Echo time


Inversion time


Thrombolysis in myocardial infarction


Repetition time


Turbo spin echo


Wall motion score index



The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Marco Francone, MD PhD, EBCR.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from all patients in this study.

Ethical approval

Institutional Review Board approval was obtained.


• retrospective

• observational

• performed at one institution


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Nicola Galea
    • 1
    • 2
  • Gian Marco Dacquino
    • 1
  • Rosa Maria Ammendola
    • 1
  • Simona Coco
    • 1
  • Luciano Agati
    • 3
  • Laura De Luca
    • 3
  • Iacopo Carbone
    • 1
  • Francesco Fedele
    • 3
  • Carlo Catalano
    • 1
  • Marco Francone
    • 1
    Email author
  1. 1.Department of Radiological, Oncological and Pathological SciencesSapienza University of Rome “Sapienza”RomeItaly
  2. 2.Department of Experimental MedicineUniversity of Rome “Sapienza”RomeItaly
  3. 3.Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric SciencesUniversity of Rome “Sapienza”RomeItaly

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