Non-invasive pressure–volume loops by cardiovascular magnetic resonance and outcome in ST–elevation myocardial infarction

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Aims: We aimed to investigate if non-invasive pressure-volume (PV) loop variables by cardiovascular magnetic resonance (CMR) are associated with all-cause mortality or heart failure compared to mean arterial blood pressure (MAP), left ventricular ejection fraction (LVEF), and stroke volume (SV) in patients with revascularized ST-elevation myocardial infarction (STEMI). Methods and results: A total of 653 STEMI-patients from the DANAMI-3 trial underwent CMR and brachial blood pressure registration after revascularization. Volumetric CMR-data and brachial blood pressure were used to generate PV loops and calculate arterial elastance, contractility, energy per ejected volume, external power, potential energy, stroke work, ventricular efficiency, and ventriculoarterial coupling. The primary outcome was a composite endpoint of all-cause mortality or hospitalization for heart failure. A total of 39 patients met the primary outcome during a maximal follow-up time of 4.7 years. Potential energy (HR 1.38, 95% CI 1.02-1.88) and ventriculo-arterial coupling (HR 1.35, 95% CI 1.03-1.78) were associated with the primary outcome after adjustments for age, sex, and infarct size. LVEF (HR 0.74, 95% CI 0.49-1.10), MAP (HR 1.12, 95% CI 0.80-1.58), and SV (HR 1.02, 95% CI 0.68-1.54) did, however, not show an association with the primary outcome. Conclusion: Non-invasive pressure-volume loop variables are prognostic of all-cause mortality and hospitalizations for heart failure independent of age, sex, and infarct size and may provide incremental prognostic information to left ventricular ejection fraction and infarct size for clinical outcome after myocardial infarction. Thus, non-invasive PV-loop variables could potentially be used for early treatment guidance in post-STEMI patients.

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