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

  • Cardiac
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Abstract

Objectives

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).

Methods

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.

Results

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).

Conclusions

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.

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Abbreviations

AAR:

Area at risk

ACE:

Angiotensin converting enzyme

AMI:

Acute myocardial infarction

ARB:

Angiotensin receptor blocker

AUC:

Area under the curve

CABG:

Coronary artery bypass graft

CMR:

Cardiac magnetic resonance

EDV:

End-diastolic volume

ESV:

End-systolic volume

HF:

Heart failure

HFPEF:

Heart failure with preserved ejection fraction

IQR:

Interquartile range

LGE:

Late gadolinium enhancement

LVEF:

Left ventricular ejection fraction

LVSD:

Left ventricular systolic dysfunction

MACE:

Major adverse cardiovascular events

MVO:

Microvascular obstruction

NSTEMI:

Non ST segment elevation myocardial infarction

PCI:

Percutaneous coronary intervention

ROC:

Receiver-operating characteristic

RV:

Right ventricle

STEMI:

ST segment elevation myocardial infarction

STIR:

Short tau inversion recovery

TE:

Echo time

TI:

Inversion time

TIMI:

Thrombolysis in myocardial infarction

TR:

Repetition time

TSE:

Turbo spin echo

WMSI:

Wall motion score index

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Funding

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

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Authors and Affiliations

  1. Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome “Sapienza”, Viale Regina Elena 324, 00161, Rome, Italy

    Nicola Galea, Gian Marco Dacquino, Rosa Maria Ammendola, Simona Coco, Iacopo Carbone, Carlo Catalano & Marco Francone

  2. Department of Experimental Medicine, University of Rome “Sapienza”, Rome, Italy

    Nicola Galea

  3. Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, University of Rome “Sapienza”, Rome, Italy

    Luciano Agati, Laura De Luca & Francesco Fedele

Authors
  1. Nicola Galea
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  2. Gian Marco Dacquino
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  5. Luciano Agati
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  9. Carlo Catalano
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  10. Marco Francone
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Correspondence to Marco Francone.

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Guarantor

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

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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

One of the authors has significant statistical expertise.

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

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Institutional Review Board approval was obtained.

Methodology

• retrospective

• observational

• performed at one institution

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Galea, N., Dacquino, G.M., Ammendola, R.M. et al. Microvascular obstruction extent predicts major adverse cardiovascular events in patients with acute myocardial infarction and preserved ejection fraction. Eur Radiol 29, 2369–2377 (2019). https://doi.org/10.1007/s00330-018-5895-z

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  • DOI: https://doi.org/10.1007/s00330-018-5895-z

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