Prognosis and risk stratification with LV global longitudinal strain and Native T1 mapping in acute myocardial infarction

Q: What are the key findings of this study?

Combined impaired LV GLS and elevated native T1 mapping identified high-risk AMI patients (adjusted HR 7.158) and outperformed contrast-enhanced CMR for MACE discrimination (C-index 0.780 vs 0.736).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute myocardial infarction (AMI) (n=1253). Intervention: Impaired LV global longitudinal strain (LV GLS >= -11%) and elevated native T1 mapping (z score >= 2.1) on non-contrast CMR vs. Minimal risk group (LV GLS = -11% and native T1 z score >= 2.1 vs. minimal risk); Model 3 vs Model 2 C-index 0.780 vs 0.736, 95% CI 3.208-14.660, p=<0.001).

Q: What does this research mean for the field?

Combining left ventricular global longitudinal strain and native T1 mapping provides incremental prognostic value for major adverse cardiac events after acute myocardial infarction and outperforms conventional contrast-enhanced cardiac MRI models. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the incremental prognostic value of combining left ventricular global longitudinal strain and native T1 mapping for predicting major adverse cardiac events after acute myocardial infarction using a non-contrast cardiac MRI strategy.

Shan Zhang; Guojun Zhu; Xingyu Gu; Jingping Wu; Lianming Wu

doi:10.1186/s12880-026-02992-y

October 28, 2026BMC Medical ImagingOpen Access

Prognosis and risk stratification with LV global longitudinal strain and Native T1 mapping in acute myocardial infarction

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Key result

Impaired LV GLS plus elevated native T1 linked to ~7.2-fold higher post-AMI MACE risk.

Adjusted HR 7.158 (High-risk group: LV GLS >= -11% and native T1 z score >= 2.1 vs. minimal risk); Model 3 vs Model 2 C-index 0.780 vs 0.736
95% CI 3.208-14.660
P<0.001
n=1,253

Why the study?

Does combining left ventricular global longitudinal strain (LV GLS) and native T1 mapping on non-contrast cardiac MRI improve prognostic risk stratification for major adverse cardiac events compared to conventional contrast-enhanced CMR markers and clinical risk scores in patients with acute myocardial infarction undergoing PCI?

Key Points

To evaluate the incremental prognostic value of combining left ventricular global longitudinal strain and native T1 mapping for predicting major adverse cardiac events after acute myocardial infarction using a non-contrast cardiac MRI strategy.
Retrospectively enrolled 1253 patients with acute myocardial infarction who underwent percutaneous coronary intervention and cardiac MRI across four centers between February 2017 and September 2024 (development cohort, n = 1002; external validation cohort, n = 251).
Assessed major adverse cardiac events, defined as all-cause death, life-threatening arrhythmias, cardiac death, reinfarction, and heart failure hospitalization, over a median follow-up of 43 months.
Major adverse cardiac events occurred in 137 participants in the development cohort and 36 participants in the external validation cohort over a median follow-up of 43 months.
In multivariable Cox analysis, native T1 z score (adjusted HR: 1.052, 95% CI: 1.032–1.116, P = 0.008) and LV GLS (adjusted HR: 1.253, 95% CI: 1.183–1.328, P < 0.001) were independent predictors of major adverse cardiac events.
The non-contrast Model incorporating clinical variables, LVEF, native T1 z score, and LV GLS showed superior discriminative ability compared to a conventional contrast-enhanced model incorporating late gadolinium enhancement, microvascular obstruction, and intramyocardial hemorrhage (C-index, 0.780 vs. 0.736; P = 0.033).

Study Design

Type

Cohort (n=1,253)

Blinding

Observers who analyzed CMR images and the physician who recorded clinical endpoints were blinded to patient outcomes and CMR data, respectively

Multicenter

Yes

Structured PICO

Does combining left ventricular global longitudinal strain (LV GLS) and native T1 mapping on non-contrast cardiac MRI improve prognostic risk stratification for major adverse cardiac events compared to conventional contrast-enhanced CMR markers and clinical risk scores in patients with acute myocardial infarction undergoing PCI?

P

Population

1,253 patients with first acute myocardial infarction undergoing PCI within 12 hours and CMR within 7 days across four centers (development n=1,002, median age 60, 73.8% male; validation n=251, median age 57, 75.2% male), followed for a median of 43 months.

E

Exposure

Combined non-contrast cardiac MRI (CMR) risk stratification model incorporating left ventricular global longitudinal strain (LV GLS) and native T1 mapping (standardized as z-scores), performed within 7 days after AMI using 3.0-T scanners

C

Comparator

Conventional contrast-enhanced CMR prognostic model (incorporating LVEF, late gadolinium enhancement [LGE] extent, microvascular obstruction [MVO], and intramyocardial hemorrhage [IMH]), as well as established risk scores (GRACE Score and Glasgow CMR Risk Score)

O

Outcome

Composite of major adverse cardiac events (MACE), defined as all-cause death, life-threatening arrhythmias (sustained ventricular tachycardia or ventricular fibrillation terminated by appropriate antitachycardia pacing or ICD shock), cardiac death, reinfarction, and hospitalization for heart failure over a median follow-up of 43 months, assessed by a physician blinded to CMR datacomposite

Main Result

Hazard Ratio: 7.158 (95% CI 3.208–14.66)

p-value: p=<0.001

Combining non-contrast cardiac MRI parameters (native T1 mapping and LV global longitudinal strain) provides superior MACE risk stratification after acute myocardial infarction compared to conventional contrast-enhanced CMR models and established clinical risk scores.

Limitations

Retrospective enrollment
Limited number of life-threatening arrhythmias and cardiac death events prevented specific subgroup survival curves
Limited number of life-threatening arrhythmias and cardiac death events prevented specific Kaplan-Meier survival analyses for these individual endpoints

Implication

May support non-contrast CMR for post-AMI MACE stratification; leaves open prospective validation versus contrast-enhanced markers.

Abstract

Background Left ventricular global longitudinal strain (LV GLS) and native T1 mapping are prognostic markers after acute myocardial infarction (AMI), but the prognostic value of their combined assessment beyond established risk stratification remains uncertain. Objective To evaluate the incremental prognostic value of combining LV GLS and native T1 mapping for major adverse cardiac events (MACE) after AMI and to assess their potential for non-contrast risk stratification. Methods AMI patients undergoing percutaneous coronary intervention (PCI) and cardiac MRI (CMR) from four centers between February 2017 and September 2024 were retrospectively enrolled. Major adverse cardiac events (MACEs) were defined as all-cause death, life-threatening arrhythmias, cardiac death, reinfarction and heart failure hospitalization. Cox regression and Kaplan-Meier analyses were used to assess the incremental prognostic value of LV strain and native T1 mapping. Results A total of 1253 participants (development cohort, n = 1002; external validation cohort, n = 251) were included in the study. Over a median follow-up of 43 months, 137 and 36 participants experienced MACE in the development and external validation cohort. In the development cohort, the non-contrast Model 3 incorporating clinical variables, LVEF, native T1 z score and LV GLS improved discrimination over Model 2 incorporating conventional contrast-enhanced CMR markers (LGE, MVO and IMH) (C-index, 0.780 vs. 0.736; P = 0.033). Native T1 and LV GLS showed better prognostic performance than the GRACE and Glasgow CMR Risk Scores. The findings were validated in the external validation cohort. Conclusion Combined native T1 mapping and LV GLS provided complementary prognostic information, improved risk stratification and reclassification beyond established risk factors, and supported the potential of a contrast-free CMR strategy that outperformed a conventional contrast-enhanced model.

Discussion

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Cite This Study

Zhang et al. (2026) conducted a cohort in Acute myocardial infarction (AMI) (n=1,253). Impaired LV global longitudinal strain (LV GLS >= -11%) and elevated native T1 mapping (z score >= 2.1) on non-contrast CMR vs. Minimal risk group (LV GLS < -11% and native T1 z score < 2.1) and conventional contrast-enhanced CMR markers (LGE, MVO, IMH) was evaluated on Major adverse cardiac events (MACE: composite of all-cause death, life-threatening arrhythmias, cardiac death, reinfarction, and heart failure hospitalization) (Adjusted HR 7.158 (High-risk group: LV GLS >= -11% and native T1 z score >= 2.1 vs. minimal risk); Model 3 vs Model 2 C-index 0.780 vs 0.736, 95% CI 3.208-14.660, p=<0.001). Combined impaired LV GLS and elevated native T1 mapping identified high-risk AMI patients (adjusted HR 7.158) and outperformed contrast-enhanced CMR for MACE discrimination (C-index 0.780 vs 0.736).

synapsesocial.com/papers/6ae207ba779bd8f3826bb2be https://doi.org/10.1186/s12880-026-02992-y

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Prognosis and risk stratification with LV global longitudinal strain and Native T1 mapping in acute myocardial infarction

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Prognosis and risk stratification with LV global longitudinal strain and Native T1 mapping in acute myocardial infarction

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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