This study demonstrates that a decreased T2-ratio of right to left ventricular blood pools measured by cardiac magnetic resonance imaging (CMR) within the first week after STEMI is associated with an increased risk of congestive heart failure (CHF). The RV/LV T2-ratio may serve as a novel prognostic biomarker for CHF development following first-time STEMI.
Background
Congestive heart failure is a frequent and serious complication after ST-segment elevation myocardial infarction (STEMI), affecting about 15% of patients within the first year and significantly impacting morbidity and mortality. Established risk factors for post-STEMI CHF include older age, female sex, diabetes, larger infarct size, microvascular obstruction, and intramyocardial hemorrhage. Recently, the ratio of T2 relaxation times between right and left ventricular blood pools (RV/LV T2-ratio) has been linked to exercise capacity in chronic heart failure and detection of cardiac shunts, but its prognostic value after STEMI remains unexplored. This study aimed to evaluate the RV/LV T2-ratio as a predictor of major adverse cardiac events, especially CHF, in first-time STEMI patients.
Data Highlights
Parameter
Measurement
Method
RV/LV T2-ratio
Calculated as 100 × T2RV/T2LV (%)
CMR T2-mapping within 1 week post-PCI
Infarct size
Absolute mass (g) and % LV mass
Late gadolinium-enhanced imaging
Microvascular obstruction (MVO)
Presence/absence
Hypoenhancement on LGE images
Intramyocardial hemorrhage (IMH)
Presence/absence
T2*-mapping with T2* < 20 ms
Primary endpoint
CHF requiring IV diuretics or hospitalization
Clinical follow-up up to 12 months
Key Findings
Lower RV/LV T2-ratios measured early post-STEMI are significantly associated with subsequent development of congestive heart failure.
The RV/LV T2-ratio below the 10th percentile identifies patients at higher risk for CHF and major adverse cardiac events (MACE).
RV/LV T2-ratio provides prognostic information beyond traditional imaging markers such as infarct size, microvascular obstruction, and intramyocardial hemorrhage.
Measurement of ventricular blood pool T2 relaxation times is feasible and reproducible using standardized CMR protocols within the first week after STEMI.
Patients with low RV/LV T2-ratios may benefit from closer clinical monitoring and early therapeutic interventions to prevent CHF progression.
Clinical Implications
The RV/LV T2-ratio is a promising noninvasive biomarker that can be incorporated into early post-STEMI CMR assessments to stratify patients at risk for congestive heart failure. Identifying high-risk individuals allows for tailored management strategies, potentially improving outcomes by guiding intensified surveillance and timely initiation of heart failure therapies. Further validation in larger cohorts may establish this parameter as a routine prognostic tool in STEMI care.
Conclusion
Decreased RV/LV T2-ratio measured by CMR shortly after STEMI is a novel and independent predictor of congestive heart failure development. This metric enhances risk stratification and may improve clinical decision-making in post-STEMI patient management.
References
MARINA-STEMI Study Protocol and Results
European Society of Cardiology Guidelines 2017 -- STEMI Management
by Felix Troger, Mathias Pamminger, Christina Tiller, Magdalena Holzknecht, Ivan Lechner, Alex Kaser, Philip Lungenschmid, Ramona Popa, Fritz Oberhollenzer, Martin Reindl, Bernhard Metzler, Sebastian J. Reinstadler, Agnes Mayr
