{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T20:20:40Z","timestamp":1790626840050,"version":"4.1.0"},"reference-count":38,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T00:00:00Z","timestamp":1782432000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Cardiac magnetic resonance (CMR) imaging provides a comprehensive assessment of myocardial injury after ST-segment elevation myocardial infarction (STEMI), yet the relative prognostic value of segmental infarct zone parameters compared with global indices for predicting left ventricular (LV) functional recovery remains incompletely defined. This study aimed to determine whether segmental infarct zone functional and structural CMR parameters provide prognostic information for LV functional recovery after a first STEMI treated with primary percutaneous coronary intervention (PCI). Methods: In this prospective single-center study, 93 patients with a first STEMI (median age 61 years; 77% male) underwent CMR at baseline (median 3 days post-PCI) and at a 6-month follow-up. The comprehensive CMR assessment included cine imaging for volumetric and feature-tracking strain analysis, T1 and T2 mapping, and late gadolinium enhancement (LGE) for infarct size (IS) and microvascular obstruction (MVO) quantification. The myocardial segments were classified as infarcted, adjacent, or remote based on the LGE distribution. The primary outcome was unfavorable LV functional recovery, defined as failure to achieve an absolute increase of &gt;10 percentage points in the LV ejection fraction (LVEF) or a follow-up LVEF \u2264 50%. Results: At the 6-month follow-up, significant reverse remodeling was observed: the LVEF improved from 49.0% [40.7\u201352.4] to 55.8% [47.9\u201359.9] (p &lt; 0.001), the LV end-systolic volume decreased from 91.8 mL [75.1\u2013113.8] to 80.8 mL [61.9\u2013108.3] (p = 0.005), and the relative IS decreased from 30.9% [18.9\u201345.5] to 19.0% [11.1\u201331.3] of LV mass (p &lt; 0.001). At the follow-up, MVO was no longer detectable in any patient. Unfavorable functional recovery occurred in 17 patients (18.3%). In the multivariable analysis, the infarct zone circumferential strain (CS) was the strongest independent predictor of unfavorable recovery (OR 8.81; 95% CI 1.98\u201339.28; p = 0.004), followed by the relative IS (OR 4.02; 95% CI 1.03\u201315.73; p = 0.045) and a lower infarct zone post-contrast T1 (OR 4.40; 95% CI 1.12\u201317.36; p = 0.034). Conclusions: Segmental infarct zone characteristics\u2014particularly circumferential strain, post-contrast T1, and infarct size\u2014provide clinically relevant prognostic information for LV functional recovery after STEMI. The infarct zone CS offers incremental predictive value beyond its structural parameters, reflecting the residual contractile reserve and myocardial viability.<\/jats:p>","DOI":"10.3390\/diagnostics16131992","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T02:16:44Z","timestamp":1782699404000},"page":"1992","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Infarct Zone Circumferential Strain Independently Predicts Left Ventricular Functional Recovery After ST-Segment Elevation Myocardial Infarction: A Multiparametric CMR Study"],"prefix":"10.3390","volume":"16","author":[{"given":"Agneta","family":"Virbickiene","sequence":"first","affiliation":[{"name":"Institute of Cardiology, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania"},{"name":"Heart Center, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivija","family":"Dobiliene","sequence":"additional","affiliation":[{"name":"Heart Center, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnoldas","family":"Leleika","sequence":"additional","affiliation":[{"name":"Heart Center, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justina","family":"Jureviciute","sequence":"additional","affiliation":[{"name":"Heart Center, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2756-0783","authenticated-orcid":false,"given":"Paulius","family":"Bucius","sequence":"additional","affiliation":[{"name":"Heart Center, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neda","family":"Jonaitiene","sequence":"additional","affiliation":[{"name":"Heart Center, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Egle","family":"Kazakauskaite","sequence":"additional","affiliation":[{"name":"Heart Center, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lina","family":"Bardauskiene","sequence":"additional","affiliation":[{"name":"Heart Center, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2389-1550","authenticated-orcid":false,"given":"Vacis","family":"Tatarunas","sequence":"additional","affiliation":[{"name":"Institute of Cardiology, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7726-6948","authenticated-orcid":false,"given":"Tomas","family":"Lapinskas","sequence":"additional","affiliation":[{"name":"Heart Center, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e93","DOI":"10.1161\/CIR.0000000000001123","article-title":"Heart Disease and Stroke Statistics\u20142023 Update: A Report from the American Heart Association","volume":"147","author":"Tsao","year":"2023","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2549","DOI":"10.1093\/eurheartj\/ehac223","article-title":"Left ventricular remodelling post-myocardial infarction: Pathophysiology, imaging, and novel therapies","volume":"43","author":"Frantz","year":"2022","journal-title":"Eur. Heart J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1949","DOI":"10.1161\/CIRCULATIONAHA.117.030693","article-title":"Cardiovascular magnetic resonance in acute st-segment-elevation myocardial infarction: Recent advances, controversies, and future directions","volume":"137","author":"Bulluck","year":"2018","journal-title":"Circulation"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2470","DOI":"10.1016\/j.jacc.2010.01.049","article-title":"Prognostic Significance and Determinants of Myocardial Salvage Assessed by Cardiovascular Magnetic Resonance in Acute Reperfused Myocardial Infarction","volume":"55","author":"Eitel","year":"2010","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1833","DOI":"10.1161\/CIRCULATIONAHA.116.022603","article-title":"Comparative Prognostic Utility of Indexes of Microvascular Function Alone or in Combination in Patients with an Acute ST-Segment-Elevation Myocardial Infarction","volume":"134","author":"Carrick","year":"2016","journal-title":"Circulation"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"oeab033","DOI":"10.1093\/ehjopen\/oeab033","article-title":"Cardiac magnetic resonance imaging improves prognostic stratification of patients with ST-elevation myocardial infarction and preserved ejection fraction","volume":"1","author":"Reindl","year":"2021","journal-title":"Eur. Heart J. Open"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"97","DOI":"10.3390\/medicina49030017","article-title":"Ischemic Heart Disease: A Comprehensive Evaluation Using Cardiovascular Magnetic Resonance","volume":"49","author":"Lapinskas","year":"2013","journal-title":"Medicina"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1297","DOI":"10.1007\/s10554-019-01542-8","article-title":"Combined T1-mapping and tissue tracking analysis predicts severity of ischemic injury following acute STEMI\u2014An Oxford Acute Myocardial Infarction (OxAMI) study","volume":"35","author":"Wamil","year":"2019","journal-title":"Int. J. Cardiovasc. Imaging"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Virbickiene, A., Lapinskas, T., Garlichs, C.D., Mattecka, S., Tanacli, R., Ries, W., Torzewski, J., Heigl, F., Pfluecke, C., and Darius, H. (2023). Imaging Predictors of Left Ventricular Functional Recovery after Reperfusion Therapy of ST-Elevation Myocardial Infarction Assessed by Cardiac Magnetic Resonance. J. Cardiovasc. Dev. Dis., 10.","DOI":"10.3390\/jcdd10070294"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1219","DOI":"10.1007\/s00330-014-3137-6","article-title":"Magnetic resonance-derived circumferential strain provides a superior and incremental assessment of improvement in contractile function in patients early after ST-segment elevation myocardial infarction","volume":"24","author":"Wong","year":"2014","journal-title":"Eur. Radiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e618","DOI":"10.1161\/CIR.0000000000000617","article-title":"Fourth Universal Definition of Myocardial Infarction (2018)","volume":"138","author":"Thygesen","year":"2018","journal-title":"Circulation"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1289","DOI":"10.1093\/eurheartj\/ehaa575","article-title":"2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC)","volume":"42","author":"Collet","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1186\/1532-429X-15-91","article-title":"Standardized cardiovascular magnetic resonance (CMR) protocols 2013 update","volume":"15","author":"Kramer","year":"2013","journal-title":"J. Cardiovasc. Magn. Reson."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/s12968-020-00610-6","article-title":"Standardized image interpretation and post-processing in cardiovascular magnetic resonance\u20142020 update","volume":"22","author":"Bluemke","year":"2020","journal-title":"J. Cardiovasc. Magn. Reson."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1081\/JCMR-120003946","article-title":"Standardized Myocardial Segmentation and Nomenclature for Tomographic Imaging of the Heart","volume":"4","author":"Cerqueira","year":"2002","journal-title":"J. Cardiovasc. Magn. Reson."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1186\/s12968-014-0085-x","article-title":"Accuracy and reproducibility of semi-automated late gadolinium enhancement quantification techniques in patients with hypertrophic cardiomyopathy","volume":"16","author":"Mikami","year":"2014","journal-title":"J. Cardiovasc. Magn. Reson."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1016\/j.jcmg.2010.11.015","article-title":"Evaluation of Techniques for the Quantification of Myocardial Scar of Differing Etiology Using Cardiac Magnetic Resonance","volume":"4","author":"Flett","year":"2011","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1186\/s12968-017-0389-8","article-title":"Clinical recommendations for cardiovascular magnetic resonance mapping of T1, T2, T2* and extracellular volume: A consensus statement by the Society for Cardiovascular Magnetic Resonance (SCMR) endorsed by the European Association for Cardiovascular Imaging (EACVI)","volume":"19","author":"Messroghli","year":"2016","journal-title":"J. Cardiovasc. Magn. Reson."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1016\/j.jacc.2020.05.075","article-title":"Heart Failure With Recovered Left Ventricular Ejection Fraction: JACC Scientific Expert Panel","volume":"76","author":"Wilcox","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e263","DOI":"10.1016\/j.jacc.2021.12.012","article-title":"2022 AHA\/ACC\/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"79","author":"Heidenreich","year":"2022","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1093\/ehjci\/jead258","article-title":"Impact of symptom-to-reperfusion-time on transmural infarct extent and left ventricular strain in patients with ST-segment elevation myocardial infarction: A 3D view on the wavefront phenomenon","volume":"25","author":"Demirkiran","year":"2024","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1016\/j.jcmg.2024.07.011","article-title":"Myocardial Strain Imaging: Theory, Current Practice, and the Future","volume":"18","author":"Smiseth","year":"2025","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1186\/s12968-017-0343-9","article-title":"Defining left ventricular remodeling following acute ST-segment elevation myocardial infarction using cardiovascular magnetic resonance","volume":"19","author":"Bulluck","year":"2017","journal-title":"J. Cardiovasc. Magn. Reson."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"22644","DOI":"10.1038\/s41598-022-26968-4","article-title":"Cardiac magnetic resonance feature tracking global and segmental strain in acute and chronic ST-elevation myocardial infarction","volume":"12","author":"Erley","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.ejrad.2019.01.010","article-title":"Predictors of segmental myocardial functional recovery in patients after an acute ST-Elevation myocardial infarction","volume":"112","author":"Mangion","year":"2019","journal-title":"Eur. J. Radiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e15725","DOI":"10.1111\/echo.15725","article-title":"Incremental prognostic value of speckle tracking echocardiography and early follow-up echo assessment in predicting left ventricular recovery after reperfusion for ST-segment elevation myocardial infarction (STEMI)","volume":"41","author":"Yehia","year":"2024","journal-title":"Echocardiography"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.1016\/j.jcmg.2018.07.019","article-title":"Effect of Early Metoprolol During ST-Segment Elevation Myocardial Infarction on Left Ventricular Strain: Feature-Tracking Cardiovascular Magnetic Resonance Substudy From the METOCARD-CNIC Trial","volume":"12","author":"Podlesnikar","year":"2019","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"8501","DOI":"10.1007\/s00330-023-09907-3","article-title":"Cardiac magnetic resonance for the early prediction of reverse left ventricular remodeling in patients with ST-segment elevation myocardial infarction","volume":"33","author":"Cui","year":"2023","journal-title":"Eur. Radiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1148\/radiol.2017162338","article-title":"Acute versus chronic myocardial infarction: Diagnostic accuracy of quantitative Native T1 and T2 mapping versus assessment of edema on Standard T2-weighted cardiovascular MR images for differentiation","volume":"285","author":"Tahir","year":"2017","journal-title":"Radiology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"9056","DOI":"10.1038\/s41598-019-45449-9","article-title":"Interrogation of the infarcted and salvaged myocardium using multi-parametric mapping cardiovascular magnetic resonance in reperfused ST-segment elevation myocardial infarction patients","volume":"9","author":"Hausenloy","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1863","DOI":"10.1007\/s00330-023-10100-9","article-title":"Contrast-enhanced cardiac MRI is superior to non-contrast mapping to predict left ventricular remodeling at 6 months after acute myocardial infarction","volume":"34","author":"Chen","year":"2024","journal-title":"Eur. Radiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"P87","DOI":"10.1186\/1532-429X-17-S1-P87","article-title":"Prediction of functional recovery by cardiac magnetic resonance feature tracking imaging in first time ST-elevation myocardial infarction. Comparison to infarct size and transmurality by late gadolinium enhancement","volume":"17","author":"Giusca","year":"2015","journal-title":"J. Cardiovasc. Magn. Reson."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Valente, F.X., Gavara, J., Gutierrez, L., Rios-Navarro, C., Rello, P., Maymi, M., Fernandez-Galera, R., Monmeneu, J.V., Sao-Aviles, A., and Lopez-Lereu, M.P. (2021). Predictive Value of Cardiac Magnetic Resonance Feature Tracking after Acute Myocardial Infarction: A Comparison with Dobutamine Stress Echocardiography. J. Clin. Med., 10.","DOI":"10.3390\/jcm10225261"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1007\/s00330-019-06338-x","article-title":"Recovery and prognostic value of myocardial strain in ST-segment elevation myocardial infarction patients with a concurrent chronic total occlusion","volume":"30","author":"Elias","year":"2020","journal-title":"Eur. Radiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1007\/s00392-020-01649-2","article-title":"Global longitudinal strain by feature tracking for optimized prediction of adverse remodeling after ST-elevation myocardial infarction","volume":"110","author":"Reindl","year":"2021","journal-title":"Clin. Res. Cardiol."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Biesbroek, P.S., Amier, R.P., Teunissen, P.F., Hofman, M.B., Robbers, L.F., van de Ven, P.M., Beek, A.M., van Rossum, A.C., van Royen, N., and Nijveldt, R. (2017). Changes in remote myocardial tissue after acute myocardial infarction and its relation to cardiac remodeling: A CMR T1 mapping study. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0180115"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Wang, J., Kong, Y., Xi, J., Zhang, M., Lu, Y., Hu, C., and Xu, K. (2023). Recovery and prognostic values of myocardial strain in acute anterior and non-anterior wall myocardial infarction. PLoS ONE, 18.","DOI":"10.1371\/journal.pone.0282027"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2052","DOI":"10.1016\/j.jacc.2024.03.408","article-title":"Clinical Outcomes Associated With Various Microvascular Injury Patterns Identified by CMR After STEMI","volume":"83","author":"Lechner","year":"2024","journal-title":"J. Am. Coll. Cardiol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/13\/1992\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T02:51:30Z","timestamp":1782701490000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/13\/1992"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,26]]},"references-count":38,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["diagnostics16131992"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16131992","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,26]]}}}