Persistent Iron Within the Infarct Core After ST-Segment Elevation Myocardial Infarction: Implications for Left Ventricular Remodeling and Health Outcomes

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

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)

Original languageEnglish
Pages (from-to)1248-1256
Number of pages9
JournalJACC: Cardiovascular Imaging
Volume11
Issue number9
Early online date15 Nov 2017
DOIs
Publication statusPublished - Sep 2018

Keywords

  • magnetic resonance imaging
  • myocardial infarction
  • remodeling

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    Carberry, J., Carrick, D., Haig, C., Ahmed, N., Mordi, I., McEntegart, M., Petrie, M. C., Eteiba, H., Hood, S., Watkins, S., Lindsay, M., Davie, A., Mahrous, A., Ford, I., Sattar, N., Welsh, P., Radjenovic, A., Oldroyd, K. G., & Berry, C. (2018). Persistent Iron Within the Infarct Core After ST-Segment Elevation Myocardial Infarction: Implications for Left Ventricular Remodeling and Health Outcomes. JACC: Cardiovascular Imaging, 11(9), 1248-1256. https://doi.org/10.1016/j.jcmg.2017.08.027