What does this research mean for the field?

Quantitative assessment of intramyocardial hemorrhage using conventional T2-weighted imaging independently predicts major adverse cardiovascular events and improves risk stratification beyond traditional risk factors in patients with reperfused STEMI. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate the prognostic value of quantitative intramyocardial hemorrhage assessed by conventional T2-weighted cardiac magnetic resonance imaging in patients with reperfused STEMI.

September 5, 2026The International Journal of Cardiovascular Imaging

Intramyocardial hemorrhage ≥1.0% of LV mass is linked to ~14% higher death and HF hospitalization risk.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: ST-elevation myocardial infarction (STEMI) (n=453). Intervention: Intramyocardial hemorrhage (IMH) extent ≥ 1.0% of LV mass on T2-weighted imaging vs. Absence of IMH or IMH extent < 1.0% of LV mass. Primary outcome: Composite of all-cause death and heart failure hospitalization (HR 1.14, 95% CI 1.07-1.21, p=<0.001).

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Why the study?

Does quantitative intramyocardial hemorrhage assessment by conventional T2-weighted imaging improve risk stratification in reperfused STEMI patients?

Population

453 patients with ST-elevation myocardial infarction who underwent CMR at a median of 5 days post-reperfusion.

Comparison

Quantitative intramyocardial hemorrhage… vs Base prognostic model without quantitative IMH…

Design

Cohort

Follow-up

median 25 months

Key result

Quantitative intramyocardial hemorrhage extent ≥1.0% of LV mass on T2-weighted imaging independently predicted all-cause death and heart failure hospitalization (HR 1.14; 95% CI 1.07-1.21; p<0.001).

Authors

ZLZhi Li ZCZhuang Chen MZMin Zhang

Discussion

Member takes

Overview

May refine post-STEMI risk stratification on routine T2-weighted CMR; hypothesis-generating and requires prospective validation before practice change.

Key Points

To evaluate the prognostic value of quantitative intramyocardial hemorrhage assessed by conventional T2-weighted cardiac magnetic resonance imaging in patients with reperfused STEMI.
Retrospectively analyzed 453 STEMI patients who underwent CMR at a median of 5 days post-reperfusion.
Quantified IMH on conventional T2-weighted imaging as a hypointense core within myocardial edema expressed as a percentage of left ventricular mass.
Evaluated primary composite outcomes of all-cause death and heart failure hospitalization over a median follow-up of 25 months.
IMH was present in 36.9% of patients (167/453) and was significantly more frequent in patients who experienced major adverse cardiac events (75.5% vs. 32.2%, p < 0.001).
Multivariable Cox regression identified IMH extent as an independent predictor of major adverse events (HR 1.14, 95% CI 1.07–1.21, p < 0.001).
Adding quantitative IMH to clinical base models increased the AUC from 0.800 to 0.828, yielding a net reclassification improvement of 12% (p < 0.001) and integrated discrimination improvement of 7% (p = 0.018).

Study Design

Type

Cohort (n=453)

Multicenter

Structured PICO

Does quantitative intramyocardial hemorrhage assessment by conventional T2-weighted imaging improve risk stratification in reperfused STEMI patients?

Population

453 STEMI patients who underwent CMR at a median of 5 days post-reperfusion, followed for a median of 25 months.

Exposure

Quantitative intramyocardial hemorrhage (IMH) assessment by conventional T2-weighted (T2W) imaging (IMH extent ≥ 1.0% of LV mass)

Comparator

Base prognostic model (anterior infarction, infarct size, microvascular obstruction, LVEF) without quantitative IMH assessment

Outcome

Composite of all-cause death and heart failure hospitalizationcomposite

Main Result

Hazard Ratio: 1.14 (95% CI 1.07–1.21)

p-value: p=<0.001

Quantitative intramyocardial hemorrhage assessment using conventional T2-weighted imaging provides significant incremental prognostic value beyond traditional risk factors in reperfused STEMI patients.

Limitations

single-center
retrospective study
selected cohort

Cite This Study

Li et al. (2026) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=453). Intramyocardial hemorrhage (IMH) extent ≥ 1.0% of LV mass on T2-weighted imaging vs. Absence of IMH or IMH extent < 1.0% of LV mass was evaluated on Composite of all-cause death and heart failure hospitalization (HR 1.14, 95% CI 1.07-1.21, p=<0.001). Quantitative intramyocardial hemorrhage extent ≥1.0% of LV mass on T2-weighted imaging independently predicted all-cause death and heart failure hospitalization (HR 1.14; 95% CI 1.07-1.21; p<0.001).

synapsesocial.com/papers/6a9c01646b95aff0620ec818 https://doi.org/10.1007/s10554-026-03812-8

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September 5, 2026The International Journal of Cardiovascular Imaging

Intramyocardial hemorrhage ≥1.0% of LV mass is linked to ~14% higher death and HF hospitalization risk.

View Full Paper

Ask AI

Bookmark

Why the study?

Does quantitative intramyocardial hemorrhage assessment by conventional T2-weighted imaging improve risk stratification in reperfused STEMI patients?

Population

453 patients with ST-elevation myocardial infarction who underwent CMR at a median of 5 days post-reperfusion.

Comparison

Quantitative intramyocardial hemorrhage… vs Base prognostic model without quantitative IMH…

Design

Cohort

Follow-up

median 25 months

Key result

Authors

ZLZhi Li ZCZhuang Chen MZMin Zhang

Discussion

Member takes

Overview

May refine post-STEMI risk stratification on routine T2-weighted CMR; hypothesis-generating and requires prospective validation before practice change.

Key Points

To evaluate the prognostic value of quantitative intramyocardial hemorrhage assessed by conventional T2-weighted cardiac magnetic resonance imaging in patients with reperfused STEMI.
Retrospectively analyzed 453 STEMI patients who underwent CMR at a median of 5 days post-reperfusion.
Quantified IMH on conventional T2-weighted imaging as a hypointense core within myocardial edema expressed as a percentage of left ventricular mass.
Evaluated primary composite outcomes of all-cause death and heart failure hospitalization over a median follow-up of 25 months.
IMH was present in 36.9% of patients (167/453) and was significantly more frequent in patients who experienced major adverse cardiac events (75.5% vs. 32.2%, p < 0.001).
Multivariable Cox regression identified IMH extent as an independent predictor of major adverse events (HR 1.14, 95% CI 1.07–1.21, p < 0.001).
Adding quantitative IMH to clinical base models increased the AUC from 0.800 to 0.828, yielding a net reclassification improvement of 12% (p < 0.001) and integrated discrimination improvement of 7% (p = 0.018).

Study Design

Type

Cohort (n=453)

Multicenter

Structured PICO

Does quantitative intramyocardial hemorrhage assessment by conventional T2-weighted imaging improve risk stratification in reperfused STEMI patients?

Population

453 STEMI patients who underwent CMR at a median of 5 days post-reperfusion, followed for a median of 25 months.

Exposure

Quantitative intramyocardial hemorrhage (IMH) assessment by conventional T2-weighted (T2W) imaging (IMH extent ≥ 1.0% of LV mass)

Comparator

Base prognostic model (anterior infarction, infarct size, microvascular obstruction, LVEF) without quantitative IMH assessment

Outcome

Composite of all-cause death and heart failure hospitalizationcomposite

Main Result

Hazard Ratio: 1.14 (95% CI 1.07–1.21)

p-value: p=<0.001

Limitations

single-center
retrospective study
selected cohort

Cite This Study

synapsesocial.com/papers/6a9c01646b95aff0620ec818 https://doi.org/10.1007/s10554-026-03812-8

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