Prognostic Value of Left-Ventricular Filling Pressure Estimated by Cardiovascular Magnetic Resonance in Patients With Acute ST-Segment Elevation Myocardial Infarction

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Background: Left-ventricular filling pressure estimated using cardiovascular magnetic resonance (LVFPcmr) provides a noninvasive measure of diastolic function and has demonstrated prognostic value comparable to invasive assessment in heart failure populations. However, data on LVFPcmr in patients following acute ST-segment elevation myocardial infarction (ASTEMI) are limited. Thus, this study aimed to evaluate the diagnostic and prognostic implications of LVFPcmr in a cohort of patients with ASTEMI. Methods: This study included 296 patients with ASTEMI who underwent cardiovascular magnetic resonance (CMR) after percutaneous coronary intervention (PCI). The primary clinical endpoint was major adverse cardiac events (MACEs), defined as a composite of death, reinfarction, and heart failure. Univariable and multivariable Cox regression analyses were used to determine the association between LVFPcmr and MACEs. Receiver operating characteristic curve and Kaplan-Meier analyses were performed to evaluate the prognostic value of LVFPcmr in patients with ASTEMI. Results: During a median follow-up of 1563 days (interquartile range: 1442–1714 days), 38 patients (12.84%) experienced MACEs. These patients exhibited significantly higher CMR-derived LVFPcmr values than those without MACEs (14.57 [13.17–15.99] vs. 13.30 [12.05–14.51] mmHg; p < 0.001). Moreover, the Youden index identified an optimal LVFPcmr cutoff of 14.30 mmHg for high-risk classification (p < 0.001). In univariable Cox regression analysis, each 1 mmHg increase in LVFPcmr was associated with a significantly higher risk of MACEs (hazard ratio [HR]: 1.31; 95% confidence interval [CI]: 1.14–1.51; p < 0.001). This association remained robust in multivariable models after adjustment for baseline covariates, left-ventricular ejection fraction, and infarct size (% of LV mass) (HR: 1.25 per 1 mmHg increase; 95% CI, 1.07–1.46; p < 0.01). The multivariable regression model yielded a Harrell C-index of 0.77, indicating strong discriminative ability for predicting MACEs. Conclusions: LVFPcmr independently predicts long-term MACEs after ASTEMI, supporting the use of this approach in post-PCI risk stratification.

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