Ramlall, Manish; (2020) Cardiac Magnetic Resonance Imaging in ST-Elevation Myocardial Infarction Patients Undergoing Primary Angioplasty. Doctoral thesis (M.D(Res)), UCL (University College London).

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Abstract

Numerous pre-clinical studies investigating remote preconditioning as a cardioprotective strategy using surrogate biochemical and imaging markers have yielded positive results. A large randomised trial is required to show whether or not RIC has a beneficial impact on clinical outcomes in STelevation myocardial infarction (STEMI) patients treated with primary angioplasty. In addition, cardiac magnetic resonance imaging derived surrogate markers are being increasingly used as prognostic tools in phase II studies. Two commonly utilised surrogate markers are infarct size and intramyocardial haemorrhage. Various imaging sequences used to assess these parameters have been utilised for clinical and research purposes. Novel motion corrected sequences, not requiring breath-holding, have been introduced to aid patient compliance and reduce motion artefacts. The performance of these sequences has not been fully investigated. The aims of this thesis are as detailed below. The first aim is to investigate whether or not remote preconditioning improves clinical outcomes in reperfused STEMI patients. I describe the set-up and findings of a large multicentre randomised trial which shows that remote preconditioning does not provide added clinical benefits after 1-year follow-up. The second aim is to compare two T2* mapping sequences used to assess intramyocardial haemorrhage. I demonstrate that the novel sequence produces fewer artefacts but has a lesser diagnostic ability than the conventional sequence. The third aim is to compare two novel motion corrected post-contrast sequences with two commonly used ones for quantifying infarct size, including the reference standard fast low-angle shot sequence. I demonstrate that there is good correlation in infarct size measured using the four sequences. In conclusion, this thesis shows that remote preconditioning does not provide additional benefit to primary angioplasty in STEMI patients and surrogate markers of adverse outcomes such as infarct size and intramyocardial haemorrhage can be measured with novel motion corrected sequences.

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