A right/left ventricular blood pool T2-ratio below 60% increased the odds of congestive heart failure after STEMI by 3.7-fold compared to higher ratios, with incidence rates of 19% vs. 6% during median 3 years follow-up.
Cohort (n=604)
Yes
Does a reduced CMR-derived right/left ventricular blood pool T2-ratio predict the development of congestive heart failure in patients after a first-time STEMI?
A reduced CMR-derived RV/LV blood pool T2-ratio (<60%) is an independent prognostic marker for the development of congestive heart failure after a first-time STEMI, providing incremental value over traditional risk factors.
Effect estimate: OR 3.7 for T2-ratio < 60% (95% CI 1.7–8.1)
Absolute Event Rate: 19% vs 6%
p-value: p=<0.001
Abstract Background T2-mapping of the blood-pool in cardiac magnetic resonance imaging (CMR) provides important information on blood-oxygenation, and differences between right and left ventricular (RV/LV) T2-relaxation times are linked to exercise capacity in heart failure. However, there are no data available on RV/LV T2-ratio after ST-segment elevation myocardial infarction (STEMI). Our aim was to investigate the prognostic value of RV/LV T2-ratio for the development of newly diagnosed congestive heart failure (CHF) post-STEMI. Methods Six hundred four patients were enrolled after revascularized first-time STEMI; all patients underwent CMR within four days afterwards (interquartile range (IQR) 2–5). T2 relaxation times were measured in the RV and LV blood pool on short-axis T2-maps; T2-ratio was calculated as T2 RV /T2 LV . Telephonic follow-ups were performed at a median observation interval of 3.0 years. CHF was defined as cardiac decompensation symptoms requiring i.v. diuretics. Results Median T2-ratio was 73% (IQR 65–80) and significantly lower in patients with newly diagnosed CHF (69% vs. 73%, p = 0.019). Dichotomized at 60% (10th percentile), patients with a reduced T2-ratio experienced CHF significantly more often (19% vs. 6%, p < 0.001) and sooner (55 vs. 485 days, p < 0.001) and were significantly older, had larger infarcts, higher peak troponin T, N-terminal pro-brain natriuretic peptide (NT-proBNP), lower LV-/RV-ejection fraction, and more commonly microvascular injuries (all p < 0.05). In logistic regression, T2-ratio < 60% emerged as an independent prognostic marker in multiparametric models including classic CHF risk factors. Addition of RV/LV T2-ratio to NT-proBNP resulted in a net reclassification improvement of 0.32 (95% CI 0.06–0.57, p = 0.016). Conclusion CMR-derived RV/LV T2-ratio is an easily applicable tool bearing prognostic potential for CHF after STEMI. Graphical Abstract In patients with acute revascularized STEMI, the ventricular blood pool T2-ratio was shown to be an independent prognostic marker of congestive heart failure in the aftermath of the initial hospitalization. CHF: congestive heart failure, LV: left ventricular, RV: right ventricular, PCI: percutaneous coronary intervention, STEMI: ST-elevation myocardial infarction.
Troger et al. (Tue,) conducted a cohort in Patients with revascularized first-time ST-segment elevation myocardial infarction (STEMI) with Killip class < 3 at time of CMR (n=604). Measurement of right/left ventricular blood pool T2-ratio via CMR vs. Higher T2-ratio was evaluated on Newly diagnosed congestive heart failure (CHF) defined as cardiac decompensation symptoms requiring intravenous diuretics after STEMI (OR 3.7 for T2-ratio < 60%, 95% CI 1.7–8.1, p=<0.001). A right/left ventricular blood pool T2-ratio below 60% increased the odds of congestive heart failure after STEMI by 3.7-fold compared to higher ratios, with incidence rates of 19% vs. 6% during median 3 years follow-up.