Incremental value of high-risk CMR attributes to predict adverse remodeling after ST-segment elevation myocardial infarction across LVEF categories

Background: A couple of cardiac magnetic resonance (CMR) attributes strongly predict adverse remodeling after ST-segment elevation myocardial infarction (STEMI); however, the value of incorporating high-risk CMR attributes, particularly, in patients with non-reduced ejection fraction, remains undetermined. This study sought to evaluate the independent and incremental predictive value of a multiparametric CMR approach for adverse remodeling after STEMI across left ventricular ejection fraction (LVEF) categories.

Methods: A total of 157 patients with STEMI undergoing primary percutaneous coronary intervention were prospectively enrolled. Adverse remodeling was defined as ≥20% enlargement in left ventricular end-diastolic volume from index admission to 3 months of follow-up.

Results: Adverse remodeling occurred in 23.6% of patients. After adjustment for clinical risk factors, a stroke volume index <29.6 mL/m², a global longitudinal strain >-7.5%, an infarct size >39.2%, a microvascular obstruction >4.9%, and a myocardial salvage index <36.4 were independently associated with adverse remodeling. The incidence of adverse remodeling increased with the increasing number of high-risk CMR attributes, regardless of LVEF (LVEF ≤ 40%: P = 0.026; 40% < LVEF < 50%: P = 0.001; LVEF ≥ 50%: P < 0.001). The presence of ≥4 high-risk attributes was an independent predictor of LV adverse remodeling (70.0% vs. 16.8%, adjusted OR 9.68, 95 CI% 3.25-28.87, P < 0.001). Furthermore, the number of high-risk CMR attributes had an incremental predictive value over reduced LVEF and baseline clinical risk factors (AUC: 0.81 vs. 0.68; P = 0.002).

Conclusions: High-risk CMR attributes showed a significant association with adverse remodeling after STEMI across LVEF categories. This imaging-based model provided incremental value for adverse remodeling over traditional clinical factors and LVEF.