DOI: 10.1161/jaha.126.049783 ISSN: 2047-9980

Septal Nonischemic Late Gadolinium Enhancement After Myocardial Infarction Is Associated With Adverse Remodeling and Improves Risk Stratification for Heart Failure Outcomes

Pengyu Zhou, Kankan Zhao, Kaisaierjiang Aisikaier, Zhixiang Dong, Xuan Ma, Yun Tang, Zhuxin Wei, Xi Jia, Xingrui Chen, Yujie Liu, Wenqing Xu, Fen Sa, Shujuan Yang, Jiaxin Wang, Fengnian Zhao, Minjie Lu, Xiuyu Chen, Shihua Zhao
Show PDF Cite

Background

The prevalence, anatomic distribution, enhancement patterns, and prognostic value of nonischemic late gadolinium enhancement (NI‐LGE) in patients with prior myocardial infarction were not systematically investigated.

Methods

A total of 948 patients (mean±SD age, 56.2±10.9 years; 88.4% men) diagnosed with prior myocardial infarction by cardiac magnetic resonance imaging were analyzed, excluding those with coexisting nonischemic cardiomyopathies or myocarditis. NI‐LGE was defined as midwall or subepicardial enhancement. Competing risk analysis was performed to mitigate the influence of competing events.

Results

Among these, NI‐LGE was observed in 78 patients (8.2%), with septal involvement present in all cases. Lower left ventricular ejection fraction (odds ratio [OR]=0.97, P =0.01) and larger end‐diastolic volume index (OR=1.01, P <0.001) were independently associated with NI‐LGE. During a median follow‐up of 69.6 months (interquartile range, 49.7–80.9 months), 99 (10.4%) and 63 (6.6%) experienced heart failure (HF)– and sudden cardiac death–related events, respectively. NI‐LGE was associated with a markedly increased risk of HF‐related events (subdistribution hazard ratio [sHR]=5.98, P <0.001) after adjusting for the confounders, but not sudden cardiac death ( P =0.65). NI‐LGE improved the model discrimination and fit performance (C‐index: 0.84–0.87; likelihood ratio: 1168.0–1106.1, both P <0.001) for the HF‐related events beyond left ventricular ejection fraction and late gadolinium enhancement extent. Moreover, NI‐LGE involving both the septum and free wall conferred a higher risk of HF‐related events than isolated septal involvement (sHR=2.42, P =0.02).

Conclusions

NI‐LGE occurs in 8.2% of patients with prior myocardial infarction, predominantly involving the interventricular septum. As a potential marker of adverse remodeling, NI‐LGE might provide incremental prognostic value for HF‐related outcomes beyond traditional markers.

More from our Archive