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The Role of the Extracellular Volume of the Infarction Zone and the Remote Myocardium in Predicting Systolic Dysfunction After the First Myocardial Infarction

Year: 2026

Type: article

Abstract: Aim. To evaluate the prognostic role of the extracellular volume (ECV) assessed by cardiac magnetic resonance imaging (MRI) in relation to systolic dysfunction and unfavorable remodeling of the left ventricular (LV) at 24 weeks after myocardial infarction (MI) and revascularization. Materials and methods. The study included 154 patients with primary MI aged 56±8 years. MRI was performed at 7–10 days and after 24 weeks, including assessment of indexed volumes, LV ejection fraction (LVEF), ECV, and patterns of ischemic and reperfusion injury. The study is registered in the international clinical trials registry with the number NCT04347434 (ClinicalTrials.gov). Results. Patients were divided into two groups after 24 weeks: Group 1 (n=24) with LVEF <50%, and Group 2 (n=130) with LVEF ≥50%. At 7–10 days, scar mass in Group 1 was 58.5 (39.5; 69.8) g vs. 17.1 (9.2; 29.7) g in Group 2 (p<0.001); microvascular obstruction was present in 23 cases (95.8%) vs. 55 (42.3%) (p<0.001). After 24 weeks, intergroup differences increased (p<0.05). Global ECV and remote myocardial ECV were significantly higher in patients with LVEF <50% both at 7–10 days and after 24 weeks compared to those with LVEF ≥50% (p<0.05). Infarct zone ECV did not differ between groups. Persistent systolic dysfunction after 24 weeks was predicted by global ECV >38.3% (p<0.001) and remote myocardial ECV >33.6% (p=0.008). Predictors of an increase in end-diastolic volume index >12% after 24 weeks in the subgroup of patients with initial systolic dysfunction were global ECV >42.8% (p=0.017) and remote myocardial ECV >35.6% (p=0.012). Conclusion. Global ECV and remote myocardial ECV measured by MRI in the acute stage of MI are predictors of persistent systolic dysfunction and unfavorable LV remodeling in the medium term.

Source: Diagnostics

DOI: 10.3390/diagnostics16162663