Myocardial Area at Risk and Salvage in reperfused acute MI Measured by Texture Analysis of Cardiac T2 Mapping and Its Prediction Value of Functional Recovery in the Convalescent Stage

Abstract To assess the ability of distinguishing the area at risk (AAR) and evaluating the prognostic abilities of T2-mapping texture analysis (TA) in reperfused acute MI, 106 patients who were diagnosed with AMI and treated with percutaneous coronary intervention (PCI) underwent acute (less than five days) enhanced cardiac magnetic resonance imaging. Of these patients, 45 of them had a subsequent CMR scan following recovery (after at least three months). Cine imaging, T2-Mapping, T2-weighted STIR imaging, and LGE imaging were performed. In the TA, regions of interest (infarcted, salvageable, and remote) were drawn by two blinded, independent readers based on LGE and T2-weighted imaging. Seven independent texture features on T2-Mapping were selected: Perc.50%, S(2,2)InvDfMom, S(2.-2)AngScMom, S(4,0)Entropy, 45dgrLngREmph, 45dgr_Fraction and 135dr_GLevNonU. Among them, 45dgr_LngREmph, 45dgr_Fraction and 135dr_GLevNonU showed more promise. The average value of 135dr_GLevNonU in the infarct zone, AAR zone, and the remote zone was: 61.96 ± 26.03, 31.811 ± 18.933 and 99.839 ± 26.231, respectively. Additionally, 135dr_GLevNonU provided the highest 0.855(± 0.083) area under the curve (AUC) from the receiver operating characteristic curve (ROC curve) for distinguishing AAR from the infarct zone. The AUC for differentiating AAR from the remote zone is 0.942 ± 0.041. Texture features are not associated with convalescent decreased strain or ejection fraction (EF) (p > 0.05) in the standard regression analysis; and cannot predict left ventricle remodeling (LVR) in the logistic regression analysis (p > 0.05). T2-mapping TA in reperfused AMI can distinguish AAR from both the infarct zone and the remote myocardial zone without LGE imaging. However, these features cannot predict patients’ functional recovery in the convalescent stage.