Pathophysiology of LV Remodeling Following STEMI: A Longitudinal Diffusion Tensor CMR Study

• Published in: JACC. Cardiovascular imaging 2023-02, Vol.16 (2), p.159-171
• Main Authors: Das, Arka, Kelly, Christopher, Teh, Irvin, Stoeck, Christian T, Kozerke, Sebastian, Sharrack, Noor, Swoboda, Peter P, Greenwood, John P, Schneider, Jürgen E, Plein, Sven, Dall'Armellina, Erica
• Format: Article
• Language: English
• Subjects: Contrast Media; Gadolinium; Humans; Magnetic Resonance Imaging, Cine - methods; Myocardial Infarction; Original Research; Percutaneous Coronary Intervention; Predictive Value of Tests; ST Elevation Myocardial Infarction - diagnostic imaging; ST Elevation Myocardial Infarction - pathology; ST Elevation Myocardial Infarction - therapy; Stroke Volume; Ventricular Function, Left; Ventricular Remodeling
• ISSN: 1936-878X; 1876-7591
• DOI: 10.1016/j.jcmg.2022.04.002

Adverse LV remodeling post-ST-segment elevation myocardial infarction (STEMI) is associated with a poor prognosis, but the underlying mechanisms are not fully understood. Diffusion tensor (DT)-cardiac magnetic resonance (CMR) allows in vivo characterization of myocardial architecture and provides unique mechanistic insight into pathophysiologic changes following myocardial infarction. This study evaluated the potential associations between DT-CMR performed soon after STEMI and long-term adverse left ventricular (LV) remodeling following STEMI. A total of 100 patients with STEMI underwent CMR at 5 days and 12 months post-reperfusion. The protocol included DT-CMR for assessing fractional anisotropy (FA), secondary eigenvector angle (E2A) and helix angle (HA), cine imaging for assessing LV volumes, and late gadolinium enhancement for calculating infarct and microvascular obstruction size. Adverse remodeling was defined as a 20% increase in LV end-diastolic volume at 12 months. A total of 32 patients experienced adverse remodeling at 12 months. Compared with patients without adverse remodeling, they had lower FA (0.23 ± 0.03 vs 0.27 ± 0.04; P < 0.001), lower E2A (37 ± 6° vs 51 ± 7°; P < 0.001), and, on HA maps, a lower proportion of myocytes with right-handed orientation (RHM) (8% ± 5% vs 17% ± 9%; P < 0.001) in their acutely infarcted myocardium. On multivariable logistic regression analysis, infarct FA (odds ratio [OR]: