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115 Persistence of Infarct Zone Oedema at 6 Months after Acute ST-elevation Myocardial Infarction: Incidence, Pathophysiology and Association with Left Ventricular Remodelling
  1. Jaclyn Carberry1,
  2. David Carrick1,
  3. Caroline Haig2,
  4. Sam Rauhalammi1,
  5. Nadeem Ahmed1,
  6. Ify Mordi1,
  7. Margaret B McEntegart1,
  8. Mark Petrie1,
  9. Hany Eteiba1,
  10. Stuart Hood1,
  11. Stuart Watkins1,
  12. Mitchell Lindsay1,
  13. Andrew Davie1,
  14. Ahmed Mahrous1,
  15. Ian Ford2,
  16. Naveed Sattar1,
  17. Paul Welsh1,
  18. Keith G Oldroyd1,
  19. Aleksandra Radjenovic1,
  20. Colin Berry1
  1. 1BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow
  2. 2Robertson Centre for Biostatistics, University of Glasgow

Abstract

Background The natural history of persistent myocardial oedema after ST-elevation myocardial infarction (STEMI) is uncertain.

Methods and ResultsPatients who sustained an acute STEMI were enrolled in a cohort study (BHF MR-MI; ClinicalTrials.gov: NCT02072850). Cardiac magnetic resonance (CMR) imaging with T2-mapping of myocardial oedema was performed at 1.5 Tesla 2 days and 6 months post-MI. Myocardial oedema was defined as infarct signal intensity (S. I.) >2 standard deviations from the mean S. I. within a remote reference region. 283 STEMI patients (mean (SD) age 59 (12) years, 75% male) were enrolled. Infarct size was 18 (13)% of left ventricular (LV) mass. At 2 days, infarct zone T2 (ms) was higher than remote zone T2 (62.9 (5.2) vs. 49.7 (2.1); p < 0.001), and this relationship persisted at 6 months (56.2 (4.1) vs. 49.7 (2.3); p < 0.001). Mean remote zone T2 did not change over time (p = 0.840) whereas infarct zone T2 decreased (p < 0.001). At 6 months, infarct zone oedema persisted in 177 (63%) patients who were more likely to have a history of hypertension (regression coefficient (95% confidence interval) 1.77 (0.99, 3.13); 0.053) and a larger initial size of infarction (1.02 (1.00, 1.05); p = 0.020) but less likely to have a history of previous PCI (0.28 (0.08, 0.99); p = 0.049), compared to patients without persistent oedema. In a multivariate analysis, infarct zone oedema at 6 months was associated with an increase in LV end-diastolic volume (9.68 (3.76, 15.61); p = 0.001).

Conclusion Persistence of oedema within the infarct zone affected the majority of patients at 6 months post-STEMI, and was associated with the initial severity of STEMI and adverse LV remodelling.

  • cardiac magnetic resonance imaging
  • myocardial oedema
  • ST-elevation myocardial infarction

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