Novel Insights into Myocardial Fibrosis in Patients with New Onset ST-Elevation Myocardial Infarction Following Percutaneous Coronary Intervention through Enhanced Cardiac Magnetic Resonance Imaging : A Prospective Cohort Study

Abstract

Background Myocardial fibrosis represents a prevalent pathological hallmark observed in a diverse range of chronic and acute cardiovascular disorders. However, relevant literature currently provides limited evidence regarding the determinants of myocardial fibrosis severity in patients with new-onset ST-Elevation Myocardial Infarction (STEMI) following successful emergent percutaneous coronary intervention (PCI) utilizing contrast-enhanced cardiac magnetic resonance (CE-CMR) imaging. Methods We prospectively enrolled a cohort of 78 patients presenting with new-onset ST-segment elevation myocardial infarction, who underwent successful emergent PCI within 12 hours from the onset of symptoms. Late Gadolinium Enhanced (LGE) was quantified employing CE-CMR, and patients were categorized into two groups based on the median LGE value. Results The median LGE was 16 (IQR 12 to 24). In comparison to patients with LGE below the median (n = 37), those in the group with LGE above the median (n = 41) exhibited significantly reduced left ventricular global radial strain, global circumferential strain, and global longitudinal strain. ( all p < 0.05). The infarcted radial segment (IRS), Infarcted circumferential segment (ICS) and infarcted longitudinal segment (ILS) exhibited significant reductions in patients with greater LGE ( all p < 0.05). The occurrence of microvascular obstruction (MVO) (p<0.001) and wall motion abnormality (WMA) (p < 0.01) were significantly higher in patients with a greater extent of LGE, despite successful reperfusion therapy. The LGE exhibited a moderate negative correlation with global circumferential segment(r= -0.547, p<0.001) and a low negative correlation with both Global Radial Segment and Global Longitudinal Segment ༈r= -0.434, p<0.001;r= -0.437, p<0.001). In the multivariate linear regression analysis model comprising gensini score, MVO, GRS, GCS, IRS and ILS, Gensini score (β=0.289;p = 0.001), the presence of MVO (β=0.378;p = 0.000) and GCS(β=−0.318; p = 0.012) emerged as the robust predictors of myocardial fibrosis. Conclusion The present study establishes a correlation between cardiac pathological structures, microcirculation, and myocardial fibrosis in the context of acute myocardial infarction. Therefore, it provides theoretical evidence from a pathological perspective regarding the progression of myocardial fibrosis in patients with new-onset STEMI following successful PCI. Trial registration The trial was registered in the Chinese Clinical Trial Registry (ChiCTR2400080282).