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Background <p>Microvascular obstruction (MVO) at cardiac magnetic resonance imaging (CMR) is a well-described risk factor for cardiac events after acute myocardial infarction (MI).</p> Objective <p>Predicting MVO using cardiac biomarkers and performing risk stratification according to extent of MVO.</p> Methods <p>We conducted a retrospective study including all patients with an acute MI and a subsequent CMR during the same hospital stay between October 2008 and August 2023. Patients were grouped according to the presence of any MVO and of relevant MVO (defined as &gt; 1.55% of LV myocardial mass). The prediction of MVO based on peak high sensitivity cardiac troponin T (hs-cTnT) levels was analyzed. Survival according to MVO status was assessed in the entire study population.</p> Results <p>We evaluated 597 patients with CMR 3&#xa0;days [interquartile range 2–4&#xa0;days] after myocardial infarction. MVO was present in 163 patients (27.3%) and relevant MVO in 100 patients (16.8%). Patients with MVO had significantly higher peak hs-cTnT levels compared to those without (<i>p</i> &lt; 0.001). An hs-cTnT cut-off value of &gt; 2455.0&#xa0;ng/L predicted present MVO (area under the curve (AUC) 0.824), while a cut-off value of 3975.0&#xa0;ng/L predicted relevant MVO (AUC 0.837). Relevant MVO was a predictor of all-cause mortality in the entire study population (hazard ratio (HR) 3.89 (1.50–10.09)), with an even stronger association in patients with an LVEF &gt; 35% (HR 5.91 (1.79–19.56)).</p> Conclusion <p>Higher peak hs-cTnT levels are strong predictors of MVO. Described cut-off values could serve as a screening tool. Relevant MVO is a significant predictor of all-cause mortality following acute MI, especially in patients with LVEF &gt; 35%.</p> Graphical abstract <p><b>Central Illustration:</b> Screening for and risk stratification based on MVO</p> <p><b>Legend:</b> Screening for microvascular obstruction after myocardial infarction and risk stratification based on extent of microvascular obstruction at cardiovascular magnetic resonance.</p> <p></p>

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Predicting MRI-diagnosed microvascular obstruction and its long-term impact after acute myocardial infarction

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月7日

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  • Johannes Brado,
  • Ramona Schmitt,
  • Manuel Hein,
  • Christian Valina,
  • Collin Steinhauer,
  • Martin Soschynski,
  • Christopher Schuppert,
  • Christopher L. Schlett,
  • Franz-Josef Neumann,
  • Dirk Westermann,
  • Philipp Ruile,
  • Philipp Breitbart

摘要

Background

Microvascular obstruction (MVO) at cardiac magnetic resonance imaging (CMR) is a well-described risk factor for cardiac events after acute myocardial infarction (MI).

Objective

Predicting MVO using cardiac biomarkers and performing risk stratification according to extent of MVO.

Methods

We conducted a retrospective study including all patients with an acute MI and a subsequent CMR during the same hospital stay between October 2008 and August 2023. Patients were grouped according to the presence of any MVO and of relevant MVO (defined as > 1.55% of LV myocardial mass). The prediction of MVO based on peak high sensitivity cardiac troponin T (hs-cTnT) levels was analyzed. Survival according to MVO status was assessed in the entire study population.

Results

We evaluated 597 patients with CMR 3 days [interquartile range 2–4 days] after myocardial infarction. MVO was present in 163 patients (27.3%) and relevant MVO in 100 patients (16.8%). Patients with MVO had significantly higher peak hs-cTnT levels compared to those without (p < 0.001). An hs-cTnT cut-off value of > 2455.0 ng/L predicted present MVO (area under the curve (AUC) 0.824), while a cut-off value of 3975.0 ng/L predicted relevant MVO (AUC 0.837). Relevant MVO was a predictor of all-cause mortality in the entire study population (hazard ratio (HR) 3.89 (1.50–10.09)), with an even stronger association in patients with an LVEF > 35% (HR 5.91 (1.79–19.56)).

Conclusion

Higher peak hs-cTnT levels are strong predictors of MVO. Described cut-off values could serve as a screening tool. Relevant MVO is a significant predictor of all-cause mortality following acute MI, especially in patients with LVEF > 35%.

Graphical abstract

Central Illustration: Screening for and risk stratification based on MVO

Legend: Screening for microvascular obstruction after myocardial infarction and risk stratification based on extent of microvascular obstruction at cardiovascular magnetic resonance.