Elevated Native T1 Values in The Remote Myocardium Supplied by Obstructive Non-infarct Related Coronary Arteries in post-STEMI CMR

Abstract

Introduction: Native T1 mapping values are elevated in acutely injured myocardium. We sought to study whether native T1 values, in the non-infarct related myocardial territories, might differ when supplied by obstructive or non-obstructive coronary arteries. Methods: Consecutive patients (N = 60, mean age 59 years) with first STEMI following primary percutaneous coronary intervention (PCI), underwent Cardiac MRI (CMR) within 5 ± 2 days. A retrospective review of coronary angiography reports classified coronary arteries as infarct related coronary artery (IRA) and non-IRA. Obstructive coronary artery disease (CAD) was defined as stenosis ≥ 50%. Native T1 values were presented using a 16-segment AHA model according to the three main coronary territories, left anterior descending (LAD), left circumflex (LCX) right coronary artery (RCA). Results: The cutoff native T1 value for predicting obstructive non-IRA LAD was 1309 msec with a sensitivity and specificity of 67% and 82%, respectively (AUC 0.76 ,95% CI 0.57 - 0.95, p = 0.04). The cutoff native T1 value for predicting obstructive non-IRA RCA was 1302 msec with a sensitivity and specificity of 83% and 55%, respectively (AUC 0.7 95% CI 0.52-0.87, p = 0.05). Logistic regression model adjusted for age and infarct size demonstrated that native T1 was an independent predictor for the obstructive non-IRAs LAD (OR 4.65; 1.32 – 26.96, p = 0.05) and RCA (OR 3.70; 1.44 - 16.35, p = 0.03). Conclusion: Elevated native T1 values are independent predictors of obstructive Non-IRA in STEMI patients. These results suggest the presence of concomitant remote myocardial impairment in the non-infarct territories with obstructive CAD.