Persistence of Infarct Zone T2 Hyperintensity at 6 Months after Acute ST-Segment-Elevation Myocardial Infarction: Incidence, Pathophysiology, and Prognostic Implications

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

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Abstract

Background - The incidence and clinical significance of persistent T2 hyperintensity after acute ST-segment-elevation myocardial infarction (STEMI) is uncertain. Methods and Results - Patients who sustained an acute STEMI were enrolled in a cohort study (BHF MR-MI: NCT02072850). Two hundred eighty-three STEMI patients (mean age, 59±12 years; 75% male) had cardiac magnetic resonance with T2 mapping performed at 2 days and 6 months post-STEMI. Persisting T2 hyperintensity was defined as infarct T2 >2 SDs from remote T2 at 6 months. Infarct zone T2 was higher than remote zone T2 at 2 days (66.3±6.1 versus 49.7±2.1 ms; P<0.001) and 6 months (56.8±4.5 versus 49.7±2.3 ms; P<0.001). Remote zone T2 did not change over time (mean change, 0.0±2.7 ms; P=0.837), whereas infarct zone T2 decreased (-9.5±6.4 ms; P<0.001). At 6 months, T2 hyperintensity persisted in 189 (67%) patients, who were more likely to have Thrombus in Myocardial Infarction flow 0 or 1 in the culprit artery (P=0.020), incomplete ST-segment resolution (P=0.037), and higher troponin (P=0.024). Persistent T2 hyperintensity was associated with NT-proBNP (N-terminal pro-B-type natriuretic peptide) concentration (0.57 on a log scale [0.42-0.72]; P=0.004) and the likelihood of adverse left ventricular remodeling (>20% change in left ventricular end-diastolic volume; 21.91 [2.75-174.29]; P=0.004). Persistent T2 hyperintensity was associated with all-cause death and heart failure, but the result was not significant (P=0.051). ΔT2 was associated with all-cause death and heart failure (P=0.004) and major adverse cardiac events (P=0.013). Conclusions - Persistent T2 hyperintensity occurs in two thirds of STEMI patients. Persistent T2 hyperintensity was associated with the initial STEMI severity, adverse remodeling, and long-term health outcome.

Original languageEnglish
Article numbere006586
JournalCirculation: Cardiovascular Imaging
Volume10
Issue number12
DOIs
Publication statusPublished - 1 Dec 2017

Keywords

  • acute coronary syndrome
  • magnetic resonance imaging
  • myocardial infarction
  • myocardium
  • prognosis

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