Author + information
- Received July 12, 2019
- Revision received September 19, 2019
- Accepted October 10, 2019
- Published online November 27, 2019.
- Beatriz Jáuregui, MD, MSca,b,
- David Soto-Iglesias, MSc, PhDa,b,
- Diego Penela, MD, PhDc,
- Juan Acosta, MD, PhDd,
- Juan Fernández-Armenta, MD, PhDe,
- Markus Linhart, MDb,
- Cheryl Terés, MDa,
- Vladimir Syrovnev, MDb,
- Fatima Zaraket, MDb,
- Vanessa Hervàs, RNb,
- Susana Prat-González, MD, PhDb,
- Rosario J. Perea, MD, PhDb,
- Manuel Morales-Ruiz, MD, PhDb,
- Wladimiro Jiménez, MD, PhDb,
- Luis Lasalvia, MD, MIBf,
- Xavier Bosch, MD, PhDb,
- José T. Ortiz-Pérez, MD, PhDb and
- Antonio Berruezo, MD, PhDa,∗ ()
- aHeart Institute, Teknon Medical Center, Barcelona, Spain
- bHospital Clínic, University of Barcelona, Barcelona, Spain
- cOspedale Guglielmo da Saliceto, Piacenza, Italy
- dHospital Universitario Virgen del Rocío, Sevilla, Spain
- eHospital Universitario Puerta del Mar, Cádiz, Spain
- fSiemens Healthineers, Tarrytown, New York
- ↵∗Address for correspondence:
Dr. Antonio Berruezo, Heart Institute, Teknon Medical Center, C/ Vilana, 12, 08022 Barcelona, Spain.
Objectives This study aimed to characterize the long-term scar remodeling process after an acute myocardial infarction (AMI) and the underlying scar-related arrhythmogenic substrate using serial late gadolinium enhancement cardiac magnetic resonance (LGE-CMR).
Background Little is known about the time course needed for completion of the scar healing process after an AMI, which can be assessed by noninvasive cardiac imaging techniques such as LGE-CMR.
Methods Fifty-six patients with revascularized ST-segment elevation AMI (STEMI) were consecutively included. LGE-CMR (3-T) was obtained at 7 days, 6 months, and 4 years after STEMI. The myocardium was segmented into 10 layers from the endocardium to epicardium, characterizing the core, border zone (BZ), and BZ channels (BZCs) using a dedicated post-processing software.
Results Mean age of the patients was 57 ± 11 years; 77% were men. Left ventricular ejection fraction improved at 6 months from 47% to 51% (p < 0.001) and remained stable at 4 years (53%; p = 0.21). Total scar mass decreased from 20.3 ± 14.6 g to 15.3 ± 13.3 g (6 months) and to 12.7 ± 11.7 g (4 years) (p < 0.001). Thirty of 56 (53%) patients showed a mean of 1.5 ± 1.3 BZCs/patient at 7 days, decreasing to 1.2 ± 1.3 (6 months) and 0.8 ± 1.0 (4 years) (p < 0.01). Only 42% of the initial BZCs remained present after 4 years. There were no arrhythmic events after a mean follow-up of 62.5 ± 7.4 months.
Conclusions CMR data post-processing permitted a dynamic assessment of quantitative and qualitative post-AMI scar characteristics. Scar size and number of BZCs steadily decreased 4 years after AMI. BZC distribution was significantly modified during this time. These dynamic parameters could be reliably assessed with CMR; their evaluation might be of prognostic value.
- arrhythmogenic substrate
- border zone channels
- cardiac magnetic resonance
- myocardial infarction
- ventricular arrhythmias
This work was supported by Agencia de Gestió d’Ajuts Universitaris i de Recerca (AGAUR), Generalitat de Catalunya (grant number 2014-SGR-471); Instituto de Salud Carlos III (ISCIII), Centro de Investigación Biomédica en Red: FIS-CIBER16 (grant number CB16/11/00354); Fondo de Investigación Sanitaria (FIS) (grant numbers PI14/00759, PI17/01968); and Ministerio de Economía y Competitividad, RETOS (grant numbers RTC-2015-3515-1, RTC-2016-5445-1). This study was partially supported by Siemens Healthineers. Dr. Lasalvia is a stockholder of Siemens Healthineers. Dr. Berruezo is a stockholder in Galgo Medical SL; and has received financial support from Siemens Healthineers. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received July 12, 2019.
- Revision received September 19, 2019.
- Accepted October 10, 2019.
- 2019 American College of Cardiology Foundation
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