Why the study?
Novel post-processing tools allow measurement of intraventricular pressure gradients on routinely obtained cine CMR, but whether these gradients are associated with clinical outcomes after STEMI was unknown.
Do CMR-derived LV-IVPGs predict MACE in patients with first STEMI?
Cohort (n=307)
Yes
Do CMR-derived LV-IVPGs predict MACE in patients with first STEMI?
Effect estimate: HR 0.959 (95% CI 0.866-1.063)
p-value: p=0.426
CMR-derived LV-IVPGs are associated with long-term MACE after STEMI but do not provide incremental prognostic value over LVEF and global longitudinal strain.
Aims Recently, novel post-processing tools have become available that measure intraventricular pressure gradients (IVPGs) on routinely obtained long-axis cine cardiac magnetic resonance (CMR) images. IVPGs provide a comprehensive overview of both systolic and diastolic left ventricular (LV) functions. Whether IVPGs are associated with clinical outcome after ST-elevation myocardial infarction (STEMI) is currently unknown. Here, we investigated the association between CMR-derived LV-IVPGs and major adverse cardiovascular events (MACE) in a large reperfused STEMI cohort with long-term outcome. Methods and results In this prospectively enrolled multi-centre cohort study, 307 patients underwent CMR within 14 days after the first STEMI. LV-IVPGs (from apex-to-base) were estimated on the long-axis cine images. During a median follow-up of 9.7 (5.9–12.5) years, MACE (i.e. composite of cardiovascular death and de novo heart failure hospitalisation) occurred in 49 patients (16.0%). These patients had larger infarcts, more often microvascular injury, and impaired LV-IVPGs. In univariable Cox regression, overall LV-IVPG was significantly associated with MACE and remained significantly associated after adjustment for common clinical risk factors (hazard ratio (HR) 0.873, 95% confidence interval (CI) 0.794–0.961, P = 0.005) and myocardial injury parameters (HR 0.906, 95% CI 0.825–0.995, P = 0.038). However, adjusted for LV ejection fraction and LV global longitudinal strain (GLS), overall LV-IVPG does not provide additional prognostic information (HR 0.959, 95% CI 0.866–1.063, P = 0.426). Conclusion Early after STEMI, CMR-derived LV-IVPGs are univariably associated with MACE and this association remains significant after adjustment for common clinical risk factors and measures of infarct severity. However, LV-IVPGs do not add prognostic value to LV ejection fraction and LV GLS.
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Konijnenberg et al. (2024) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=307). CMR-derived left ventricular intraventricular pressure gradients (LV-IVPGs) was evaluated on MACE (composite of cardiovascular death and de novo heart failure hospitalisation) (HR 0.959, 95% CI 0.866-1.063, p=0.426).
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