Xin Liu, Jifang He, Bowen Zhang, Lu Liang, Bin Sun, Boqia Xie, Xiuqin Jia, Xiaojuan Guo, Jing An, Chen Zhang, René M Botnar, Claudia Prieto, Karl P Kunze, Rohan Dharmakumar, Hsin-Jung Yang, Qi Yang
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引用次数: 0
Abstract
Background: Clinical adoption of cardiovascular magnetic resonance (CMR) for risk stratification in ST-elevation myocardial infarction (STEMI) is often limited by long scan times and the requirement for breath-holding and contrast agents.
Objectives: This study aimed to validate a non-contrast, free-breathing 3D whole-heart T1/T2 CMR method (iT2prep-IR BOOST) for rapid assessment of myocardial injury in STEMI patients, hypothesizing that this technique provides promising diagnostic accuracy and quantitative assessment to conventional contrast-enhanced CMR.
Methods: A free-breathing 3D isotropic whole-heart iT2prep-IR BOOST sequence was performed with a scan time of <8minutes. Sixty-four STEMI patients underwent CMR, including iT2prep-IR BOOST, clinical T2-STIR, late gadolinium enhancement (LGE) and T1/T2 mapping. The diagnostic performance of iT2prep-IR BOOST was evaluated against LGE and T2-STIR to assess myocardial infarction (MI), microvascular obstruction (MVO), and edema. Subgroup analyses further investigated the association between MVO detected by iT2prep-IR BOOST and left ventricular (LV) remodeling at 1-year follow-up.
Results: In 60 STEMI patients, the acquisition was completed in 7.2 ± 0.6min as a single free-breathing 3D whole-heart scan. Patient-level analysis showed high sensitivity and specificity for MVO (100.0% / 87.5%) and segmental MVO detection (95.8% / 97.8%). T2prep-IR BOOST yielded robust image contrast for MI comparable to LGE, while offering comparable edema visualization to T2-STIR. Volumetric and transmurality quantifications of MVO, MI, and edema showed excellent agreement with reference standards (all r > 0.90, p < 0.001), supported by significant biophysical correlations with native T1/T2 values (p < 0.001). Furthermore, in a 1-year follow-up cohort (n=51), baseline T2prep-IR BOOST-derived MVO volume was associated with adverse left ventricular remodeling, showing significant correlations with both ΔLVEDVI (r = 0.305, p = 0.029) and ΔLVESVI (r = 0.293, p = 0.037).
Conclusions: In this preliminary single-center study, iT2prep-IR BOOST showed promising diagnostic performance and close quantitative agreement with conventional LGE and T2-STIR in stable STEMI patients. Further prospective validation in larger, independent, and more heterogeneous cohorts, including patients unable to undergo contrast-enhanced CMR, is required before this technique can be considered an alternative to standard LGE and T2-weighted sequences.
期刊介绍：
Journal of Cardiovascular Magnetic Resonance (JCMR) publishes high-quality articles on all aspects of basic, translational and clinical research on the design, development, manufacture, and evaluation of cardiovascular magnetic resonance (CMR) methods applied to the cardiovascular system. Topical areas include, but are not limited to:
New applications of magnetic resonance to improve the diagnostic strategies, risk stratification, characterization and management of diseases affecting the cardiovascular system.
New methods to enhance or accelerate image acquisition and data analysis.
Results of multicenter, or larger single-center studies that provide insight into the utility of CMR.
Basic biological perceptions derived by CMR methods.
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