Baseline LV ejection fraction by cardiac magnetic resonance and 2D echocardiography after ST-elevation myocardial infarction – influence of infarct location and prognostic impact

Abstract Aims To evaluate the prognostic validity of clinical risk factors as well as infarct characterization and myocardial deformation by cardiac magnetic resonance (CMR) in ST-elevation myocardial infarction (STEMI) patients with preserved left ventricular ejection fraction (LVEF) following primary percutaneous coronary intervention (PCI). Methods and Results This multicenter, individual patient-data analysis from two large CMR trials included 1247 STEMI patients. CMR examinations were conducted 3 (interquartile range[IQR]:2-4) days after PCI. LVEF, infarct size, microvascular obstruction (MVO) and myocardial strain values were measured. Primary endpoint was defined as composite of major adverse cardiovascular events (MACE) including death, re-infarction and congestive heart failure. A preserved LVEF (defined as LVEF ≥50%) was observed in 724 patients (=58%). In the overall cohort, 97 patients experienced a MACE event (follow-up time 12 [IQR:12-13] months), and 34 MACE events occurred in the group with preserved LVEF (5%, versus 12% incidence rate in patients with LVEF<50%). TIMI risk score (hazard ratio[HR]:1.28[95%CI:1.02-1.59];p=0.03) and female gender (HR:2.24[95%CI:1.10-4.57];p=0.03) emerged as independent clinical determinants of MACE in the patient group with preserved LVEF. Among CMR parameters, presence of MVO (HR:2.39[95%CI:1.05-5.46];p=0.04) and reduced global longitudinal strain (GLS; HR:1.12[95%CI:1.02-1.23];p=0.02) independently predicted MACE in the LVEF-preserved population. The addition of MVO and GLS to the clinical prognostic markers (TIMI risk score, female gender) increased (p = 0.02) the prognostic validity (AUC:0.76[95%CI:0.73-0.79]) compared to the clinical markers alone (AUC:0.65[0.62-0.69]). Conclusion In contemporary treated STEMI patients showing preserved LVEF, a CMR-based risk prediction approach assessing MVO and GLS provided strong prognostic value that was incremental to clinical outcome parameters.

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Using proximity extension proteomics assay to identify biomarkers associated with infarct size and ejection fraction after ST-elevation myocardial infarction

Scientific Reports ◽

10.1038/s41598-020-75399-6 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Moman A. Mohammad ◽

Sasha Koul ◽

Anna Egerstedt ◽

J. Gustav Smith ◽

Marko Noc ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Myocardial Infarction ◽

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Ejection Fraction ◽

Infarct Size ◽

Cardiac Magnetic Resonance Imaging ◽

Resonance Imaging ◽

St Elevation ◽

Inflammatory Proteins

Abstract Plasma concentrations of many cardiovascular and inflammatory proteins are altered after ST-elevation myocardial infarction (STEMI) and may provide prognostic information. We conducted a large-scale proteomic analysis in patients with STEMI, correlating protein levels to infarct size and left ventricular ejection fraction (LVEF) determined with cardiac magnetic resonance imaging. We analysed 131 cardiovascular and inflammatory proteins using a multiplex proximity extension assay and blood samples obtained at baseline, 6, 24, and 96 h from the randomised clinical trial CHILL-MI. Cardiac magnetic resonance imaging data at 4 ± 2 days and 6 months were available as per trial protocol. Using a linear regression model with bootstrap resampling and false discovery rate adjustment we identified five proteins (ST2, interleukin-6, pentraxin-3, interleukin-10, renin, and myoglobin) with elevated values corresponding to larger infarct size or worse LVEF and four proteins (TNF-related apoptosis-inducing ligand, TNF-related activation induced cytokine, interleukin-16, and cystatin B) with values inversely related to LVEF and infarct size, concluding that among 131 circulating inflammatory and cardiovascular proteins in the acute and sub-acute phase of STEMI, nine showed a relationship with infarct size and LVEF post-STEMI, with IL-6 and ST2 exhibiting the strongest association.

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