P3266Differential impact of impaired renal function and acute heart failure on short- and long-term mortality in patients undergoing primary PCI for STEMI

Abstract

a canine model with MI, with higher T2 values in the infarct. We investigated its reproducibility in the clinical setting using native T1-and T2-mapping CMR in ST-segment elevation myocardial infarction (STEMI) patients treated by primary percutaneous coronary intervention (PPCI). Methods: We included STEMI patients with CMR performed at median of 3 (2-4) days, and excluded those with late microvascular obstruction, intramyocardial haemorrhage or >75% transmural extent of infarct. One short-axis slice per patient of native T1-mapping by Modified Look-Locker Inversion sequence, T2-mapping, and late gadolinium enhancement (LGE) images were analysed. Manual ROIs were drawn in the infarcted, salvaged and remote myocardium using CVI42 (Figure 1). Results: Out of 48 STEMI patients, 15 met the inclusion criteria. Majority (13/15) were males with median age of 56 (42-67) years old. Median MI size was 19 (10-28)% of the left ventricle (%LV) and area-at-risk was 39 (31-53)%LV. T2 values in the infarcted and salvaged myocardium were higher than remote myocardium (T2infarct: 64±5ms versus T2remote: 48±3ms, P<0.001; T2salvage 62±7ms versus T2remote: 48±3ms; P<0.001). However, there was no difference between T2infarct and T2salvage (P=0.45). A similar pattern was observed with native T1 mapping (T1infarct: 1284±81ms versus T1remote: 993±49ms; P<0.001; T1salvage 1235±61ms versus T1remote: 993±49ms, P<0.001, T1infarct versus T1salvage; P=0.38). Conclusion: Native T1 and T2-mapping CMR were unable to distinguish between infarcted and salvaged myocardium in reperfused STEMI patients. LGE remains the gold standard for identifying infarcted myocardium, whereas T1 and T2-mapping remain the reference to detect oedema-based area-at-risk.