Key result
Prolonged pulmonary transit time on CMR is linked to ~58% higher MACE risk after STEMI.
Why the study?
The prognostic value of pulmonary transit time (pTT) measured by cardiac magnetic resonance imaging after reperfused STEMI was not established.
Does prolonged pulmonary transit time assessed by cardiac magnetic resonance imaging predict major adverse cardiac events in patients after reperfused STEMI?
Cohort (n=207)
No
Does prolonged pulmonary transit time assessed by cardiac magnetic resonance imaging predict major adverse cardiac events in patients after reperfused STEMI?
Hazard Ratio: 1.58 (95% CI 1.12–2.22)
p-value: p=0.009
CMR-derived pulmonary transit time serves as a novel, independent functional marker providing incremental prognostic value for risk stratification after STEMI.
May enhance post-STEMI risk stratification; leaves open clinical utility pending prospective validation.
OBJECTIVES: To investigate the prognostic value of pulmonary transit time (pTT) determined by cardiac magnetic resonance (CMR) after acute ST-segment-elevation myocardial infarction (STEMI). METHODS: Comprehensive CMR examinations were performed in 207 patients 3 days and 4 months after reperfused STEMI. Functional parameters and infarct characteristics were assessed. PTT was defined as the interval between peaks of gadolinium contrast time-intensity curves in the right and left ventricles in first-pass perfusion imaging. Cox regression models were calculated to assess the association between pTT and the occurrence of major adverse cardiac events (MACE), defined as a composite of death, re-infarction, and congestive heart failure. RESULTS: PTT was 8.6 s at baseline and 7.8 s at the 4-month CMR. In Cox regression, baseline pTT (hazard ratio [HR]: 1.58; 95% CI: 1.12 to 2.22; p = 0.009) remained significantly associated with MACE occurrence after adjustment for left ventricular ejection fraction (LVEF) and cardiac index. The association of pTT and MACE remained significant also after adjusting for infarct size and microvascular obstruction size. In Kaplan-Meier analysis, pTT ≥ 9.6 s was associated with MACE (p < 0.001). Addition of pTT to LVEF resulted in a categorical net reclassification improvement of 0.73 (95% CI: 0.27 to 1.20; p = 0.002) and integrated discrimination improvement of 0.07 (95% CI: 0.02 to 0.13; p = 0.007). CONCLUSIONS: After reperfused STEMI, CMR-derived pTT was associated with hard clinical events with prognostic information independent of and incremental to infarct size and LV systolic function. KEY POINTS: • Pulmonary transit time is the duration it takes the heart to pump blood from the right chambers across lung vessels to the left chambers. • This prospective single-centre study showed inferior outcome in patients with prolonged pulmonary transit time after myocardial infarction. • Pulmonary transit time assessed by magnetic resonance imaging added incremental information to established prognostic markers.
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Pamminger et al. (2022) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=207). Prolonged pulmonary transit time (pTT) vs. Shorter pulmonary transit time was evaluated on Major adverse cardiac events (MACE: composite of all-cause death, myocardial re-infarction, and re-hospitalisation for new congestive heart failure) (HR 1.58, 95% CI 1.12-2.22, p=0.009). Prolonged baseline pulmonary transit time measured by cardiac magnetic resonance imaging was associated with an increased risk of major adverse cardiac events after reperfused STEMI (HR 1.58).
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