CMR-Derived Extracellular Volume Radiomics in Reperfused STEMI: Long-Term Prognostic Value and Risk Stratification

Jin-Yi Xiang; Yi-Si Dai; Jin-Yu Zheng; Ling-Yi Yu; Jiani Hu; Allen Song; Luke Wesemann; Jun Pu; E Mark Haacke; Lian-Ming Wu

doi:10.1093/ehjci/jeaf140

CMR-Derived Extracellular Volume Radiomics in Reperfused STEMI: Long-Term Prognostic Value and Risk Stratification

Eur Heart J Cardiovasc Imaging. 2025 May 8:jeaf140. doi: 10.1093/ehjci/jeaf140. Online ahead of print.

Authors

Affiliations

¹ Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
² Department of Radiology, Wayne State University, Detroit, MI, USA.
³ Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

PMID: 40338050
DOI: 10.1093/ehjci/jeaf140

Abstract

Aims: Global extracellular volume (ECV) fraction independently predicts outcomes after STEMI, but microvascular injuries complicate its interpretation. This study aims to assess the prognostic value of ECV-derived radiomics (RadScore) from cardiac magnetic resonance (CMR) for risk stratification in reperfused ST-elevation myocardial infarction (STEMI) patients.

Methods and results: We retrospectively included 441 reperfused STEMI patients (mean age 60±11 years; 371 males) from two centers, divided into development (n=347) and validation cohort (n=94) by centers. CMR scan was performed one week within the index event. ECV mapping was obtained from pre- and post-contrast T1 mappings. A radiomics score (RadScore) was developed through radiomics analysis on ECV mapping, and its predictive performance for major adverse cardiovascular events (MACE) was evaluated via logistic and Cox regression analyses. Over a median 3.1-year follow-up, MACE occurred in 81 patients (18.4%). RadScore showed strong predictive capability with an area under the curve (AUC) of 0.865 (95% confidence inerval [CI]: 0.768-0.962) and 0.821 (95%CI: 0.701-0.940) on the internal and external test cohort respectively, reclassifying 44% and 32% of patients over clinical model respectively. Patients with RadScore above the optimal threshold (RS+) experienced a more than 12-fold increase in MACE risk (95%CI: 2.96-47.71, P<0.001) after adjusting for known risk factors. RS+ provide incremental prognostic value beyond LVEF.

Conclusion: RadScore derived from ECV mapping was able to predict MACE and provided incremental prognostic value beyond established risk factors. Our findings underscore the potential long-term impact of acute changes in extracellular space patterns after myocardial infarction.

Keywords: Acute myocardial infarction; STEMI; extracellular volume; radiomic analysis.

© The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.