Rethinking post-infarction remodelling: identification and validation of data-driven cardiac MRI phenotypes for risk stratification
Authors' conclusion
Three reproducible post-MI remodelling phenotypes were identified, which provide superior risk stratification for MACE over conventional ALVR criteria and insights into post-MI heart failure.
Study context
- Population
- Patients with reperfused ST-elevation myocardial infarction (STEMI) who underwent cardiac magnetic resonance (CMR) at <7 days and 6-month follow-upderivation cohort 337 · validation cohort 190
- Participants
- 175 / 96 / 66
- Exposure
- Data-driven post-MI remodelling phenotypes vs. the Low-Risk group
- Low Riskn = 175reference
- Early Remodellingn = 96
- Atrial-dominant Remodellingn = 66
- Outcome
- Phenotype-stratified MACE-free survival
Methodological detailsderivation cohort and independent validation cohort, unsupervised clustering algorithm
- Derivation cohort and independent validation cohort
- Unsupervised clustering algorithm
Main finding
As reported in the abstract
- Derivation
- P < 0.001
- Validation
- P = 0.002
Observational data: associations, not effects.
Further findings
| Outcome | Estimate | |
|---|---|---|
| MACE (validation cohort)Early Remodellingvs Low Risk | HR 4.73 (95% CI 1.77–12.64) | |
| MACE (validation cohort)Atrial-dominant Remodellingvs Low Risk | HR 4.02 (95% CI 1.49–10.88) | |
| Heart failure hospitalization (validation cohort)Atrial-dominant Remodellingvs Low Risk | subdistribution HR 5.92 (95% CI 1.04–33.56) | |
| 0.050.21520Ratio (log scale) |
Major adverse cardiovascular events (MACE) discrimination
- C-index with phenotypes added to baseline CMR parameters vs. baseline CMR parameters
- 0.755 vs. 0.714
- ΔC
- 0.041, 95% CI: 0.006-0.074
- Conventional adverse left ventricular remodelling (ALVR) did not improve MACE discrimination
Original publication
Rethinking post-infarction remodelling: identification and validation of data-driven cardiac MRI phenotypes for risk stratification. Eur Heart J Cardiovasc Imaging. Published 22 May 2026. doi:10.
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