Cardiovascular magnetic resonance imaging-derived intraventricular pressure gradients in ST-segment elevation myocardial infarction: a long-term follow-up study

Recently, novel post-processing tools have become available that measure intraventricular pressure gradients (IVPG) on routinely obtained long-axis cine cardiac magnetic resonance (CMR) images. IVPGs provide a comprehensive overview of both systolic and diastolic left ventricular (LV) function. Whether IVPGs are associated with clinical outcome after ST-elevation myocardial infarction (STEMI) is currently unknown. Here, we investigated the association between CMR-derived LV-IVPGs and major adverse cardiovascular events (MACE) in a large reperfused STEMI cohort with long-term outcome. In this prospectively enrolled multicentre cohort study, 307 patients underwent CMR within 14 days after first STEMI. LV-IVPGs (from apex-to-base) were estimated on the long-axis cine images. During a median follow-up of 9.7 [5.9-12.5] years, MACE (i.e., composite of cardiovascular death and de novo heart failure hospitalisation) occurred in 49 patients (16.0%). These patients had larger infarcts, more often microvascular injury and impaired LV-IVPGs. In univariable Cox regression, overall LV-IVPG was significantly associated with MACE and remained significantly associated after adjustment for common clinical risk factors (HR 0.873, 95% CI 0.794-0.961, p = 0.005) and myocardial injury parameters (HR 0.906, 95% CI 0.825-0.995, p = 0.038). However, adjusted for LV ejection fraction and LV global longitudinal strain, overall LV-IVPG does not provide additional prognostic information (HR 0.959, 95% CI 0.866-1.063, p = 0.426). Early after STEMI, CMR-derived LV-IVPGs are univariably associated with MACE and this association remains significant after adjustment for common clinical risk factors and measures of infarct severity. However, LV-IVPGs do not add prognostic value to LV ejection fraction and LV global longitudinal strain.