Author + information
- Jaclyn Carberry,
- David Carrick,
- Caroline Haig,
- Nadeem Ahmed,
- Vannesa T.Y. May,
- Margaret McEntegart,
- Hany Eteiba,
- M. Mitchell Lindsay,
- Stuart Hood,
- Stuart Watkins,
- Andrew Davie,
- Ahmad Mahrous,
- Ify Mordi,
- Ian Ford,
- Aleksandra Radjenovic,
- Keith Oldroyd and
- Colin Berry
Background: Myocardial hemorrhage and myocardial edema can persist for up to 6 months post-STEMI. We aimed to assess the interaction between the two separate pathologies, the incidence of co-existing hemorrhage and edema, and the prognostic significance of the persistence of both at 6 months post-STEMI
Methods: Patients who sustained an acute STEMI were enrolled in a single center cohort study (BHF MR-MI; NCT02072850). Cardiac magnetic resonance (CMR) imaging, including T2*- and T2-mapping for the investigation of myocardial hemorrhage and edema respectively, was performed at 1.5 Tesla (Siemens MAGNETOM Avanto (Erlangen, Germany)) at 2 days and 6 months post-STEMI. Myocardial hemorrhage was defined as a hypointense infarct core with T2* signal <20ms. Myocardial edema was defined as infarct signal intensity >2 standard deviations from the mean signal intensity within a remote reference region. Patient outcomes were independently reviewed for all-cause death or unplanned hospitalization for heart failure and major adverse cardiovascular events (MACE).
Results: 241 patients (mean±SD age 58±11 years, 77% male) had evaluable T2* and T2 maps at 6 months post-STEMI. At 6 months, 52 (22%) patients had persistent myocardial hemorrhage and 145 (60%) had persistent myocardial edema. There was no association between persisting edema and persisting hemorrhage (p=0.750).
74 (31%) patients had neither edema or hemorrhage, 22 (9%) had hemorrhage only, 115 (48%) had edema only and 30 (12%) had both edema and hemorrhage.
Compared to the presence of neither or the presence of isolated hemorrhage or edema, the persistence of both myocardial edema and hemorrhage was associated with a higher risk of all-cause death and heart failure (n=16 events, n=5 in edema and hemorrhage; OR 3.43 (1.19, 9.88); p=0.022) and MACE (n=15 events, n=5 in edema and hemorrhage; 3.70 (1.26, 10.82): p=0.017) after the 6 month CMR scan and up to 4 years follow-up.
Conclusions: Persistence of both myocardial hemorrhage and edema at 6 months post-STEMI is uncommon but is associated with an approximately 3 times increased risk of all-cause death or hospitalization for heart failure and approximately 4 times increased risk of MACE in the longer term.
Room 140 B
Sunday, March 19, 2017, 8:38 a.m.-8:48 a.m.
Session Title: Highlighted Original Research: Non Invasive Imaging and the Year in Review
Abstract Category: 29. Non Invasive Imaging: MR
Presentation Number: 909-08
- 2017 American College of Cardiology Foundation