TY - JOUR
T1 - Persistent Iron Within the Infarct Core After ST-Segment Elevation Myocardial Infarction
T2 - Implications for Left Ventricular Remodeling and Health Outcomes
AU - Carberry, Jaclyn
AU - Carrick, David
AU - Haig, Caroline
AU - Ahmed, Nadeem
AU - Mordi, Ify
AU - McEntegart, Margaret
AU - Petrie, Mark C.
AU - Eteiba, Hany
AU - Hood, Stuart
AU - Watkins, Stuart
AU - Lindsay, Mitchell
AU - Davie, Andrew
AU - Mahrous, Ahmed
AU - Ford, Ian
AU - Sattar, Naveed
AU - Welsh, Paul
AU - Radjenovic, Aleksandra
AU - Oldroyd, Keith G.
AU - Berry, Colin
PY - 2018/9
Y1 - 2018/9
N2 -
Objectives: This study sought to determine the incidence and prognostic significance of persistent iron in patients post–ST-segment elevation myocardial infarction (STEMI). Background: The clinical significance of persistent iron within the infarct core after STEMI complicated by acute myocardial hemorrhage is poorly understood. Methods: Patients who sustained an acute STEMI were enrolled in a cohort study (BHF MR-MI [Detection and Significance of Heart Injury in ST Elevation Myocardial Infarction]). Cardiac magnetic resonance imaging including T
2
* (observed time constant for the decay of transverse magnetization seen with gradient-echo sequences) mapping was performed at 2 days and 6 months post-STEMI. Myocardial hemorrhage or iron was defined as a hypointense infarct core with T
2
* signal <20 ms. Results: A total of 203 patients (age 57 ± 11 years, n = 158 [78%] male) had evaluable T
2
* maps at 2 days and 6 months post-STEMI; 74 (36%) patients had myocardial hemorrhage at baseline, and 44 (59%) of these patients had persistent iron at 6 months. Clinical associates of persistent iron included heart rate (p = 0.009), the absence of a history of hypertension (p = 0.017), and infarct size (p = 0.028). The presence of persistent iron was associated with worsening left ventricular (LV) end-diastolic volume (regression coefficient: 21.10; 95% confidence interval [CI]: 10.92 to 31.27; p < 0.001) and worsening LV ejection fraction (regression coefficient: −6.47; 95% CI: −9.22 to −3.72; p < 0.001). Persistent iron was associated with the subsequent occurrence of all-cause death or heart failure (hazard ratio: 3.91; 95% CI: 1.37 to 11.14; p = 0.011) and major adverse cardiac events (hazard ratio: 3.24; 95% CI: 1.09 to 9.64; p = 0.035) (median follow-up duration 1,457 days [range 233 to 1,734 days]). Conclusions: Persistent iron at 6 months post-STEMI is associated with worse LV and longer-term health outcomes. (Detection and Significance of Heart Injury in ST Elevation Myocardial Infarction [BHF MR-MI]; NCT02072850)
AB -
Objectives: This study sought to determine the incidence and prognostic significance of persistent iron in patients post–ST-segment elevation myocardial infarction (STEMI). Background: The clinical significance of persistent iron within the infarct core after STEMI complicated by acute myocardial hemorrhage is poorly understood. Methods: Patients who sustained an acute STEMI were enrolled in a cohort study (BHF MR-MI [Detection and Significance of Heart Injury in ST Elevation Myocardial Infarction]). Cardiac magnetic resonance imaging including T
2
* (observed time constant for the decay of transverse magnetization seen with gradient-echo sequences) mapping was performed at 2 days and 6 months post-STEMI. Myocardial hemorrhage or iron was defined as a hypointense infarct core with T
2
* signal <20 ms. Results: A total of 203 patients (age 57 ± 11 years, n = 158 [78%] male) had evaluable T
2
* maps at 2 days and 6 months post-STEMI; 74 (36%) patients had myocardial hemorrhage at baseline, and 44 (59%) of these patients had persistent iron at 6 months. Clinical associates of persistent iron included heart rate (p = 0.009), the absence of a history of hypertension (p = 0.017), and infarct size (p = 0.028). The presence of persistent iron was associated with worsening left ventricular (LV) end-diastolic volume (regression coefficient: 21.10; 95% confidence interval [CI]: 10.92 to 31.27; p < 0.001) and worsening LV ejection fraction (regression coefficient: −6.47; 95% CI: −9.22 to −3.72; p < 0.001). Persistent iron was associated with the subsequent occurrence of all-cause death or heart failure (hazard ratio: 3.91; 95% CI: 1.37 to 11.14; p = 0.011) and major adverse cardiac events (hazard ratio: 3.24; 95% CI: 1.09 to 9.64; p = 0.035) (median follow-up duration 1,457 days [range 233 to 1,734 days]). Conclusions: Persistent iron at 6 months post-STEMI is associated with worse LV and longer-term health outcomes. (Detection and Significance of Heart Injury in ST Elevation Myocardial Infarction [BHF MR-MI]; NCT02072850)
KW - magnetic resonance imaging
KW - myocardial infarction
KW - remodeling
UR - http://www.scopus.com/inward/record.url?scp=85034454433&partnerID=8YFLogxK
U2 - 10.1016/j.jcmg.2017.08.027
DO - 10.1016/j.jcmg.2017.08.027
M3 - Article
C2 - 29153575
AN - SCOPUS:85034454433
SN - 1936-878X
VL - 11
SP - 1248
EP - 1256
JO - JACC: Cardiovascular Imaging
JF - JACC: Cardiovascular Imaging
IS - 9
ER -