Prognostic value of extracellular volume fraction in myocardial infarction and myocardial infarction with nonobstructive coronary arteries: A multicenter study

Bowen Li; Yan Gao; Jian Wang; Runze Zhu; Shifeng Yang; Congshan Ji; Ying Wang; Ximing Wang; Hui Gu

doi:10.1016/j.acra.2024.11.015

Prognostic value of extracellular volume fraction in myocardial infarction and myocardial infarction with nonobstructive coronary arteries: A multicenter study

Acad Radiol. 2024 Nov 22:S1076-6332(24)00860-2. doi: 10.1016/j.acra.2024.11.015. Online ahead of print.

Authors

Bowen Li¹, Yan Gao², Jian Wang³, Runze Zhu¹, Shifeng Yang⁴, Congshan Ji⁴, Ying Wang⁴, Ximing Wang², Hui Gu⁵

Affiliations

¹ Shandong First Medical University (Shandong Academy of Medical Sciences), Jinan Shandong 250117, China (B.L., R.Z.); Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China (B.L., Y.G., R.Z., S.Y., C.J., Y.W., X.W., H.G.).
² Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong 250021, China (Y.G., X.W., H.G.); Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China (B.L., Y.G., R.Z., S.Y., C.J., Y.W., X.W., H.G.).
³ Department of Radiology, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China (J.W.).
⁴ Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China (B.L., Y.G., R.Z., S.Y., C.J., Y.W., X.W., H.G.).
⁵ Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong 250021, China (Y.G., X.W., H.G.); Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China (B.L., Y.G., R.Z., S.Y., C.J., Y.W., X.W., H.G.). Electronic address: hui_gu07@126.com.

PMID: 39580248
DOI: 10.1016/j.acra.2024.11.015

Abstract

Rationale and objectives: The aim of the present retrospective study was to evaluate the prognostic role of the extracellular volume fraction (ECV) in patients with myocardial infarction (MI) and myocardial infarction with nonobstructive coronary arteries (MINOCA). The present study hypothesized that ECV is associated with major adverse cardiovascular events (MACEs) in MI and MINOCA patients.

Materials and methods: Cardiac magnetic resonance (CMR) imaging was performed on 351 consecutive patients (mean age: 58 ± 12 years; 252 [71.8%] males) who were diagnosed with MI between October 2015 and November 2023. From CMR imaging, the extent of late gadolinium enhancement (LGE), native T1 and ECV were derived. Patients were categorized into groups according to the degree of coronary artery stenosis, namely, patients with MINOCA and patients with obstructive MI. Follow-up was performed to assess MACEs.

Results: The final cohort consisted of 61 MINOCA patients and 290 obstructive MI patients. During a mean follow-up of 27 ± 16 months, there was no statistically significant difference in the incidence of MACEs between patients with MINOCA and those with obstructive MI, and the two groups of patients had similar ECVs (32.2 ± 3.6 vs. 32.3 ± 6.0, p = 0.864). According to the multivariate Cox regression, ECV was an independent predictor of MACEs (HR: 1.13; p < 0.001) and significantly improved the prognostic value of the baseline multivariate models (C-statistic improvement: 0.816-0.864, p = 0.001). Similarly, ECV maintained an independent association with MACEs in the MINOCA (HR: 1.35; p < 0.001) and obstructive MI (HR: 1.13; p < 0.001) groups.

Conclusion: In MI and MINOCA patients, ECV is an independent predictor of MACEs. MINOCA is not a benign disease, and its long-term prognosis is as poor as that of patients with obstructive MI.

Keywords: Cardiac magnetic resonance imaging; Major adverse cardiac events; Myocardial infarction; Myocardial infarction with nonobstructive coronary arteries; Prognosis.