Microvascular perfusion patterns identified by contrast-enhanced CMR: prognostic implications in STEMI
Bibliographic record
Abstract
Abstract Background Microvascular obstruction (MVO) after STEMI is a known predictor of adverse outcomes. On CMR, MVO is more frequently seen on early gadolinium enhancement (EGE) but can shrink or even disappear by late gadolinium enhancement (LGE), suggesting a wide spectrum of microvascular injuries. The clinical significance of these microvascular perfusion patterns (MPP) remains unclear. Purposes To evaluate the prognostic value of MPP derived from sequential EGE and LGE imaging in STEMI patients. Materials and Methods This retrospective single-center study analyzed 584 STEMI patients (mean age 60 ± 11 years; 87% male) undergoing CMR. MPP was categorized into four groups based on hypointense core on EGE (3-minute) and LGE (10-minute) image: No MVO, Reversible MVO (EGE-MVO+/LGE-MVO−), Partially Resolved MVO (LGE-MVO/EGE-MVO <30%), and Minimally Resolved MVO (≥30%). The threshold was determined as the median ratio of LGE-MVO over EGE-MVO among patients with LGE-MVO. Major adverse cardiovascular events (MACE: all-cause mortality, heart failure, reinfarction) were analyzed using Cox regression and Fine-Gray competing-risk models. Results Among participants, MPP distributed as follows: No MVO (n=157, 26.8%), Reversible MVO (n=133, 22.8%), Partially Resolved MVO (n=147, 25.2%), and Minimally Resolved MVO (n=147, 25.2%) (See Figure 1). Patients with worse microvascular perfusion had higher High-sensitivity cardiac troponin I (hs-cTNI, P<0.001) and C-reactive protein (CRP, P=0.029). Over a 3.1-year median follow-up (IQR: 1.6–4.6 years), 103 patients occurred MACE (17.6%), with escalating event rates from No MVO to Minimally Resolved MVO (See Figure 2). Patients with Reversible MVO exhibited elevated event rates (P=0.041) despite similar survival with No MVO group (log-rank P=0.07). Minimally Resolved MVO emerged as the most strong predictor of MACE, associated with a 6-fold higher MACE risk (HR: 6.11, 95% CI: 2.79–13.36; P<0.001), driven predominantly by heart failure (HR: 3.34, 95% CI: 1.02 - 10.96, P=0.047) and non-target vessel reinfarctions (HR: 5.00, 95% CI: 1.39 - 18.00, P=0.014), not all-cause mortality (P>0.05). Compared to the Canadian Cardiovascular Society (CCS) classification for myocardial infarction1, MPP exhibited a net reclassification improvement of 22.0% (95% CI: 4.9–33.8%; P<0.001) and provided incremental prognostic value beyond CCS stages. Conclusion MPP was associated with prognosis and demonstrated superior risk stratification compared to the Static CCS stages in STEMI, highlighting the clinical utility of MVO perfusion dynamics.Figure 1.Representative Figures Figure 2.Survival Analysis
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".