Remote myocardial fibrosis predicts adverse outcome in patients with myocardial infarction on clinical cardiovascular magnetic resonance imaging

作者：Nicholas Black, Joshua Bradley, Erik B. Schelbert, Laura Bonnett, Gavin A. Lewis, Jakub Lagan, Christopher Orsborne, Pamela Frances Brown, Fardad Soltani, Fredrika Fröjdh, Martin Ugander, Timothy C. Wong, Miho Fukui, João L. Cavalcante, Josephine H. Naish, Simon G. Williams, Theresa A. McDonagh, Matthias Schmitt, Christopher A. Miller · 发表于：Journal of Cardiovascular Magnetic Resonance · 年份：2024 · DOI：10.1016/j.jocmr.2024.101064 · 被引用次数：11 · 研究领域：Cardiac Imaging and Diagnostics、Cardiac Fibrosis and Remodeling、Cardiovascular Function and Risk Factors

Heart failure (HF) most commonly occurs in patients who have had a myocardial infarction (MI), but factors other than MI size may be deterministic. Fibrosis of myocardium remote from the MI is associated with adverse remodeling. We aimed to 1) investigate the association between remote myocardial fibrosis, measured using cardiovascular magnetic resonance (CMR) extracellular volume fraction (ECV), and HF and death following MI, 2) identify predictors of remote myocardial fibrosis in patients with evidence of MI and determine the relationship with infarct size. Multicenter prospective cohort study of 1199 consecutive patients undergoing CMR with evidence of MI on late gadolinium enhancement. Median follow-up was 1133 (895–1442) days. Cox proportional hazards modeling was used to identify factors predictive of the primary outcome, a composite of first hospitalization for HF (HHF) or all-cause mortality, post-CMR. Linear regression modeling was used to identify determinants of remote ECV. Remote myocardial fibrosis was a strong predictor of primary outcome (χ2: 15.6, hazard ratio [HR]: 1.07 per 1% increase in ECV, 95% confidence interval [CI]: 1.04–1.11, p < 0.001) and was separately predictive of both HHF and death. The strongest predictors of remote ECV were diabetes, sex, natriuretic peptides, and body mass index, but, despite extensive phenotyping, the adjusted model R2 was only 0.283. The relationship between infarct size and remote fibrosis was very weak. Myocardial fibrosi...