2026-04-18T01:56:24Zhttps://recercat.cat/oai/request

oai:recercat.cat:11351/105272024-12-13T10:44:07Zcom_2072_378071com_2072_378040col_2072_378097

MRI Investigation of the Differential Impact of Left Ventricular Ejection Fraction After Myocardial Infarction in Elderly vs. Nonelderly Patients to Predict Readmission for Heart Failure Marcos-Garcés, Víctor Merenciano Gonzalez, Hector Gavara Doñate, Jose Gabaldón-Pérez, Ana Lopez-Lereu, María P. Monmeneu, José V. De Carvalho Negrao Valente, Filipa Xavier Alonso Tello, Albert Maymí-Ballesteros, Manel Rodríguez Palomares, Jose Fernando Rello, Pau Imatgeria per ressonància magnètica Infart de miocardi - Complicacions Cor - Ventricle esquerre ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Diagnosis::Diagnostic Techniques and Procedures::Diagnostic Imaging::Tomography::Magnetic Resonance Imaging DISEASES::Cardiovascular Diseases::Heart Diseases::Myocardial Ischemia::Myocardial Infarction PHENOMENA AND PROCESSES::Circulatory and Respiratory Physiological Phenomena::Cardiovascular Physiological Phenomena::Ventricular Function::Ventricular Function, Left TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::diagnóstico::técnicas y procedimientos diagnósticos::diagnóstico por imagen::tomografía::imagen por resonancia magnética ENFERMEDADES::enfermedades cardiovasculares::enfermedades cardíacas::isquemia miocárdica::infarto de miocardio FENÓMENOS Y PROCESOS::fenómenos fisiológicos respiratorios y circulatorios::fenómenos fisiológicos cardiovasculares::función ventricular::función ventricular izquierda Acute heart failure; Acute myocardial infarction; Elderly Insuficiència cardíaca aguda; Infart agut de miocardi; Gent gran Insuficiencia cardíaca aguda; Infarto agudo de miocardio; Anciano Background Patients with ST-segment elevation myocardial infarction (STEMI), especially elderly individuals, have an increased risk of readmission for acute heart failure (AHF). Purpose To study the impact of left ventricular ejection fraction (LVEF) by MRI to predict AHF in elderly (>70 years) and nonelderly patients after STEMI. Study Type Prospective. Population Multicenter registry of 759 reperfused STEMI patients (23.3% elderly). Field Strength/Sequence 1.5-T. Balanced steady-state free precession (cine imaging) and segmented inversion recovery steady-state free precession (late gadolinium enhancement) sequences. Assessment One-week MRI-derived LVEF (%) was quantified. Sequential MRI data were recorded in 579 patients. Patients were categorized according to their MRI-derived LVEF as preserved (p-LVEF, ≥50%), mildly reduced (mr-LVEF, 41%–49%), or reduced (r-LVEF, ≤40%). Median follow-up was 5 [2.33–7.54] years. Statistical Tests Univariable (Student's t, Mann–Whitney U, chi-square, and Fisher's exact tests) and multivariable (Cox proportional hazard regression) comparisons and continuous-time multistate Markov model to analyze transitions between LVEF categories and to AHF. Hazard ratios (HR) with 95% confidence intervals (CIs) were computed. P < 0.05 was considered statistically significant. Results Over the follow-up period, 79 (10.4%) patients presented AHF. MRI-LVEF was the most robust predictor in nonelderly (HR 0.94 [0.91–0.98]) and elderly patients (HR 0.94 [0.91–0.97]). Elderly patients had an increased AHF risk across the LVEF spectrum. An excess of risk (compared to p-LVEF) was noted in patients with r-LVEF both in nonelderly (HR 11.25 [5.67–22.32]) and elderly patients (HR 7.55 [3.29–17.34]). However, the mr-LVEF category was associated with increased AHF risk only in elderly patients (HR 3.66 [1.54–8.68]). Less transitions to higher LVEF states (n = 19, 30.2% vs. n = 98, 53%) and more transitions to AHF state (n = 34, 53.9% vs. n = 45, 24.3%) were observed in elderly than nonelderly patients. Data Conclusion MRI-derived p-LVEF confers a favorable prognosis and r-LVEF identifies individuals at the highest risk of AHF in both elderly and nonelderly patients. Nevertheless, an excess of risk was also found in the mr-LVEF category in the elderly group. Evidence Level 2. Technical Efficacy Stage 2. Grant sponsor: This work was supported by “Instituto de Salud Carlos III” and “Fondos Europeos de Desarrollo Regional FEDER” (grant numbers PI20/00637, PI15/00531, and CIBERCV16/11/00486, CIBERCV16/11/00420, CIBERCV16/11/00479, and CM21/00175 to V.M.-G.), Fundació La Marató TV3 (grant 20153030-31-32), La Caixa Banking Foundation (HR17-00527) and by Conselleria de Educación – Generalitat Valenciana (PROMETEO/2021/008). J.G. acknowledges financial support from the “Agencia Estatal de Investigación” (grant FJC2020-043981-I/AEI/10.13039/501100011033). 2023-11-08T15:25:44Z 2023-11-08T15:25:44Z 2023-11-08T15:25:44Z 2023-10-27T10:42:55Z 2023-10-27T10:42:55Z 2023-11 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion http://hdl.handle.net/11351/10527 Journal of Magnetic Resonance Imaging;58(5) https://doi.org/10.1002/jmri.28632 Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/ info:eu-repo/semantics/openAccess Wiley Scientia