Impact of apical and mid-ventricular transmural infarcts in patients with acute myocardial infarction determined by using late gadolinium enhancement combined with feature tracking magnetic resonance

Junchao Li; Menglu Li; Yundai Chen; Liuquan Cheng; Geng Qian; Jiayue Li; Xiao Zhou; Bohan Liu; Wei Dong

doi:10.21037/cdt-21-382

Impact of apical and mid-ventricular transmural infarcts in patients with acute myocardial infarction determined by using late gadolinium enhancement combined with feature tracking magnetic resonance

Cardiovasc Diagn Ther. 2022 Feb;12(1):103-113. doi: 10.21037/cdt-21-382.

Authors

Junchao Li¹, Menglu Li², Yundai Chen¹, Liuquan Cheng², Geng Qian¹, Jiayue Li¹, Xiao Zhou¹, Bohan Liu^{3

4}, Wei Dong¹

Affiliations

¹ Senior Department of Cardiology, the Sixth Medical Center of PLA General Hospital, Beijing, China.
² Department of Radiology, the Sixth Medical Center of PLA General Hospital, Beijing, China.
³ Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing, China.
⁴ Beijing Key Laboratory of Chronic Heart Failure Precision Medicine, Chinese PLA General Hospital, Beijing, China.

Abstract

Background: To analyze the relationship between left ventricular (LV) myocardial strain and transmurality of myocardial infarction at three circular sections (basal, mid-ventricular, apical) by a combined analysis of cardiac magnetic resonance feature tracking (CMR-FT) and late gadolinium enhancement (LGE) information in a cohort of ST-elevation acute myocardial infarction (STEMI) patients after primary percutaneous coronary intervention (PPCI).

Methods: In all, 136 patients with STEMI who underwent PPCI within 12 hours of symptom onset were included. CMR-FT and LGE-MRI were performed 5±2 days after PCI for measuring regional and global myocardial strain indexes and transmural extent. Multivariate regression analysis and Kaplan-Meier survival analysis were performed.

Results: Regional radial and circumferential strain decreased with increasing transmurality of myocardial infarction irrespective of basal, mid-ventricular, or apical segments. Segmental longitudinal strain was significantly decreased in the transmural infarcted segments only at the apical and mid-ventricular levels. A significant correlation was found between the number of transmural infarcts and global strain parameters in the apical and mid-ventricular portions. Transmural infarcted segments in apical + mid-ventricular portions >2 was related to an increased risk of cardiac events in patients with STEMI following PPCI than those ≤2. GLS was found to be an independent predictor of cardiac events in these patients.

Conclusions: The number of transmural infarcted segments in apical + mid-ventricular portions affects LV global function and prognosis. Global longitudinal strain (GLS) is a significant predictor of adverse events after PPCI for STEMI. Morphologic and functional data fused to study complex pathophysiologic processes of LV early after STEMI may help in risk stratification of patients.

Keywords: Feature tracking technique; acute myocardial infarction (AMI); cardiac magnetic resonance (CMR); myocardial strain.