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Increased oxygenation is associated with myocardial inflammation and adverse regional remodeling after acute ST-segment elevation myocardial infarction

  • Cardiac
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Abstract

Objectives

To explore the relationships between oxygenation signal intensity (SI) with myocardial inflammation and regional left ventricular (LV) remodeling in reperfused acute ST-segment elevation myocardial infarction (STEMI) using oxygenation-sensitive cardiovascular magnetic resonance (OS-CMR).

Methods

Thirty-three STEMI patients and 22 age- and sex-matched healthy volunteers underwent CMR. The protocol included cine function, OS imaging, precontrast T1 mapping, T2 mapping, and late gadolinium enhancement (LGE) imaging. A total of 880 LV segments were included for analysis based on the American Heart Association 16-segment model. For validation, 15 pigs (10 myocardial infarction (MI) model animals and 5 controls) received CMR and were sacrificed for immunohistochemical analysis.

Results

In the patient study, the acute oxygenation SI showed a stepwise rise among remote, salvaged, and infarcted segments compared with healthy myocardium. At convalescence, all oxygenation SI values besides those in infarcted segments with microvascular obstruction decreased to similar levels. Acute oxygenation SI was associated with early myocardial injury (T1: r = 0.38; T2: r = 0.41; all p < 0.05). Segments with higher acute oxygenation SI values exhibited thinner diastolic walls and decreased wall thickening during follow-up. Multivariable regression modeling indicated that acute oxygenation SI (β = 2.66; p < 0.05) independently predicted convalescent segment adverse remodeling (LV wall thinning). In the animal study, alterations in oxygenation SI were correlated with histological inflammatory infiltrates (r = 0.59; p < 0.001).

Conclusions

Myocardial oxygenation by OS-CMR could be used as a quantitative imaging biomarker to assess myocardial inflammation and predict convalescent segment adverse remodeling after STEMI.

Key Points

• Oxygenation signal intensity (SI) may be an imaging biomarker of inflammatory infiltration that could be used to assess the response to anti-inflammatory therapies in the future.

• Oxygenation SI early after myocardial infarction (MI) was associated with left ventricular segment injury at acute phase and could predict regional functional recovery and adverse remodeling late after acute MI.

• Oxygenation SI demonstrated a stepwise increase among remote, salvaged, and infarcted segments. Infarcted zones with microvascular obstruction demonstrated a higher oxygenation SI than those without. However, the former showed less pronounced changes over time.

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Abbreviations

DWT:

Diastolic wall thickness

LGE:

Late gadolinium enhancement

LV:

Left ventricular

MI:

Myocardial infarction

MVO:

Microvascular obstruction

OS-CMR:

Oxygenation-sensitive cardiovascular magnetic resonance

SI:

Signal intensity

STEMI:

ST-segment elevation myocardial infarction

SWT:

Systolic wall thickness

TR:

Repetition time

Wth:

Wall thickening

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Funding

This study has received funding by the 1–3–5 project for disciplines of excellence of West China Hospital, Sichuan University (ZYGD18013).

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Authors and Affiliations

  1. Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China

    Ke Shi, Meng-Xi Yang, Chun-Chao Xia, Wan-Lin Peng, Zhen-Lin Li & Zhi-Gang Yang

  2. Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China

    Min Ma & Yong He

  3. State Key Laboratory of Biotherapy and Cancer Center, Sichuan University, Chengdu, Sichuan, China

    Meng-Xi Yang

  4. Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China

    Ying-Kun Guo

Authors
  1. Ke Shi
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Corresponding author

Correspondence to Zhi-Gang Yang.

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The scientific guarantor of this publication is Prof. Zhi-Gang Yang.

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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

No complex statistical methods were necessary for this paper.

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

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Institutional Review Board approval was obtained.

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Shi, K., Ma, M., Yang, MX. et al. Increased oxygenation is associated with myocardial inflammation and adverse regional remodeling after acute ST-segment elevation myocardial infarction. Eur Radiol 31, 8956–8966 (2021). https://doi.org/10.1007/s00330-021-08032-3

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  • DOI: https://doi.org/10.1007/s00330-021-08032-3

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