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 is a prevalent pathological hallmark of a diverse range of chronic and acute cardiovascular disorders. However, the 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 imaging (CE-CMR).

Methods: We prospectively enrolled a cohort of 78 patients who presented with new-onset ST-segment elevation myocardial infarction and who underwent successful emergent PCI within 12 h from the onset of symptoms. Late gadolinium-enhanced LGE (LGE) was quantified via CE-CMR, and patients were categorized into two groups on the basis of the median LGE value.

Results: The median LGE was 16% (IQR 12 to 24). Compared with patients with LGE below the median (n = 37), those with LGE above the median (n = 41) presented significantly reduced left ventricular global radial strain(GRS), global circumferential strain(GCS), and global longitudinal strain(GLS) (all p < 0.05). The infarcted radial segment (IRS), infarcted circumferential segment (ICS) and infarcted longitudinal segment (ILS) were significantly reduced in patients with greater LGE (all p < 0.05). The occurrence rates of microvascular obstruction (MVO) (p < 0.001) and wall motion abnormality (WMA) (p < 0.01) were significantly greater in patients with a greater extent of LGE, despite successful reperfusion therapy. LGE exhibited a moderate negative correlation with the global circumferential segment (r=-0.547, p < 0.001) and a weak negative correlation with both the global radial segment and the global longitudinal segment (r=-0.434, p < 0.001; r=-0.437, p < 0.001). In the multivariable linear regression analysis model, the Gensini score (β = 0.258; p < 0.01), LVEF% (β=-0.269; p < 0.05), MVO (β = 0.343; p < 0.001) and GRS (β = 0.227; p < 0.05) emerged as robust predictors of myocardial fibrosis.

Conclusion: The present study revealed a correlation of cardiac pathological structure, microcirculation, and myocardial fibrosis in the context of acute myocardial infarction. Therefore, this study 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; January 25th, 2024).

Keywords: Acute ST-segment elevation myocardial infarction; Cardiac magnetic resonance; Late gadolinium enhancement; Myocardial fibrosis.

Fig. 1

Flow diagram of the patient population

Fig. 2

Correlation analysis between the percentage of late gadolinium enhancement (LGE) and global circumferential strain (GCS)

Fig. 3

Correlation analysis between the percentage of late gadolinium enhancement (LGE) and global radial strain (GRS)

Fig. 4

Correlation analysis between the percentage of late gadolinium enhancement (LGE) and global longitudinal strain (GLS)

Fig. 5

A. A 65-year-old female patient with acute anterior and interventricular septal ST-elevation myocardial infarction (STEMI). Cardiac magnetic resonance imaging (CMR) revealed a high-intensity signal area (red arrow) of late gadolinium enhancement (%LGE = 26.23%) and a low-intensity area (white arrow) indicating microvascular obstruction (MVO) with a volume of 9.63 mL%. B. The corresponding left ventricular myocardial radial strain, circumferential strain, and longitudinal strain of the patient

Fig. 6

A. A 66-year-old female patient with acute ST-elevation myocardial infarction (STEMI). Cardiac magnetic resonance imaging (CMR) examination revealed a high-intensity signal area of late gadolinium enhancement (LGE) (Patient’s %LGE = 24.77%). B. The corresponding left ventricular myocardial radial strain, the left ventricular myocardial circumferential strain and the left ventricular myocardial longitudinal strain of the patient

Fig. 7

A. A 65-year-old male patient with acute anterior wall ST-elevation myocardial infarction (STEMI) underwent a cardiac magnetic resonance imaging (CMR) examination 7 days after interventional percutaneous transluminal coronary intervention (PCI). CMR revealed a high-intensity signal area (red arrow) of late gadolinium enhancement (LGE) (patient’s %LGE = 47.76%) and a low-intensity signal area (white arrow) of microvascular obstruction (MVO). B. The corresponding left ventricular myocardial radial strain, the left ventricular myocardial circumferential strain and the left ventricular myocardial longitudinal strain of the patient

Fig. 8

A 50-year-old patient with an anterior wall and interventricular septum myocardial infarction accompanied by microvascular obstruction (MVO). In the image, blue represents normal myocardium, yellow indicates infarcted myocardium, and orange–red highlights MVO within the infarct zone. CVI42 software was used to segment each myocardial layer, allowing precise determination of the infarct area and quantification of the volume of microcirculatory dysfunction