Author + information
- Received April 26, 2017
- Revision received August 21, 2017
- Accepted August 30, 2017
- Published online September 3, 2018.
- Jaclyn Carberry, BMedSci, MBChBa,∗,
- David Carrick, MBChB, PhDa,b,∗,
- Caroline Haig, PhDc,
- Nadeem Ahmed, BMedSci, MBChBa,
- Ify Mordi, MBChBa,
- Margaret McEntegart, MBChB, PhDa,
- Mark C. Petrie, MBChB, MDa,
- Hany Eteiba, MBChB, MDa,
- Stuart Hood, MBChB, MDa,
- Stuart Watkins, MBChB, MDa,b,
- Mitchell Lindsay, MBChB, MDa,
- Andrew Davie, MBChB, MDa,
- Ahmed Mahrous, MBChBa,
- Ian Ford, PhDc,
- Naveed Sattar, MBChB, PhDa,
- Paul Welsh, PhDa,
- Aleksandra Radjenovic, PhDa,
- Keith G. Oldroyd, MBChB, MDa and
- Colin Berry, MBChB, PhDa,b,∗ ()
- aBritish Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
- bWest of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland
- cRobertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland
- ↵∗Address for correspondence:
Prof. Colin Berry, British Heart Foundation, Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, 126 University Place, University of Glasgow, Glasgow G12 8TA, Scotland, United Kingdom.
Objectives This study sought to determine the incidence and prognostic significance of persistent iron in patients post–ST-segment elevation myocardial infarction (STEMI).
Background The clinical significance of persistent iron within the infarct core after STEMI complicated by acute myocardial hemorrhage is poorly understood.
Methods Patients who sustained an acute STEMI were enrolled in a cohort study (BHF MR-MI [Detection and Significance of Heart Injury in ST Elevation Myocardial Infarction]). Cardiac magnetic resonance imaging including T2* (observed time constant for the decay of transverse magnetization seen with gradient-echo sequences) mapping was performed at 2 days and 6 months post-STEMI. Myocardial hemorrhage or iron was defined as a hypointense infarct core with T2* signal <20 ms.
Results A total of 203 patients (age 57 ± 11 years, n = 158 [78%] male) had evaluable T2* maps at 2 days and 6 months post-STEMI; 74 (36%) patients had myocardial hemorrhage at baseline, and 44 (59%) of these patients had persistent iron at 6 months. Clinical associates of persistent iron included heart rate (p = 0.009), the absence of a history of hypertension (p = 0.017), and infarct size (p = 0.028). The presence of persistent iron was associated with worsening left ventricular (LV) end-diastolic volume (regression coefficient: 21.10; 95% confidence interval [CI]: 10.92 to 31.27; p < 0.001) and worsening LV ejection fraction (regression coefficient: −6.47; 95% CI: −9.22 to −3.72; p < 0.001). Persistent iron was associated with the subsequent occurrence of all-cause death or heart failure (hazard ratio: 3.91; 95% CI: 1.37 to 11.14; p = 0.011) and major adverse cardiac events (hazard ratio: 3.24; 95% CI: 1.09 to 9.64; p = 0.035) (median follow-up duration 1,457 days [range 233 to 1,734 days]).
Conclusions Persistent iron at 6 months post-STEMI is associated with worse LV and longer-term health outcomes. (Detection and Significance of Heart Injury in ST Elevation Myocardial Infarction [BHF MR-MI]; NCT02072850)
↵∗ Drs. Carberry and Carrick contributed equally to this work.
Funding was provided by a British Heart Foundation (BHF) grant (RE/13/5/30177; PG/11/2/28474) and the Chief Scientist Office. This project was also supported by a research agreement with Siemens Healthcare. Prof. Berry was supported by a Senior Fellowship from the Scottish Funding Council. Dr. Welsh is supported by BHF Fellowship FS/12/62/29889. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 26, 2017.
- Revision received August 21, 2017.
- Accepted August 30, 2017.
- 2018 The Authors