Cardiac Magnetic Resonance Evaluation of LV Remodeling Post-Myocardial Infarction: Prognosis, Monitoring and Trial Endpoints.

Adverse left ventricular remodeling (ALVR) and subsequent heart failure after myocardial infarction (MI) remain a major cause of patient morbidity and mortality worldwide. Overt inflammation has been identified as the common pathway underlying myocardial fibrosis and development of ALVR post-MI. With its ability to simultaneously provide information about cardiac structure, function, perfusion, and tissue characteristics, cardiac magnetic resonance (CMR) is well poised to inform prognosis and guide early surveillance and therapeutics in high-risk cohorts. Further, established and evolving CMR-derived biomarkers may serve as clinical endpoints in prospective trials evaluating the efficacy of novel anti-inflammatory and antifibrotic therapies. This review provides an overview of post-MI ALVR and illustrates how CMR may help clinical adoption of novel therapies via mechanistic or prognostic imaging markers. [Display omitted] • HF secondary to MI remains a public health challenge. • As a clinical tool, CMR is the modality of choice in post-MI patients because it can reliably inform myocardial function and structure—including infarct size—and can be used for serial assessment of ALVR and risk stratification in patients post-MI. • As a translational tool with the unique ability of identifying myocardial inflammation and fibrosis, CMR has the potential for the following: 1) to offer insights in the mechanisms of action of novel therapies, beyond laboratory markers; and 2) to provide standardized imaging endpoints for treatment trials. • CMR is well poised to play a key role in accelerating the adoption of novel therapies from bench to bedside, paving the way for large-scale trials with hard clinical outcomes in the population of patients after MI. [ABSTRACT FROM AUTHOR]