本研究旨在调查微血管障碍对急性ST段抬高心肌梗死（STEMI）后远端心肌性特征改变的影响，以及其在多个时间点和预后中的预测意义。患者进行基线、30天和6个月的CMR，并前瞻性入组。主要终点为主要不良心血管事件（MACE）：死亡、心肌再梗死、恶性心律失常和心力衰竭住院。使用Cox比例风险回归模型分析估计病人中有无微血管梗塞（MVO）的远端心肌T1映射与MACE之间的相关性。共纳入了135名患者（平均年龄60.72岁，女性占12.70％，中位随访510天），其中86人（63.70％）有MVO，26人（19.26％）发生了MACE。远端心肌的原生T1值发生了动态改变。在1周和30天时，有MVO组的远端心肌T1值高于没有MVO组（p = 0.030和p = 0.001，分别）。在对135名患者的多变量Cox回归分析中，native1w T1（HR 1.03，95％CI 1.01-1.04，p = 0.002），native30D T1（HR 1.05，95％CI 1.03-1.07，p <0.001）和LGE（HR 1.10，95％CI 1.05-1.15，p <0.001）是MACE的联合独立预测因子。在86名MVO患者的多元Cox回归分析中，native30D T1（HR 1.05，95％CI 1.04-1.07，p <0.001）和LGE（HR 1.10，95％CI 1.05-1.15，p <0.001）是MACE的联合独立预测因子。远端心肌原生T1值的演变与复流损伤后微血管障碍的程度有关。在MVO患者中，native30D T1和LGE是MACE的联合独立预测因子。©2023年作者（们）。

This study aimed to investigate the influence of microvascular impairment on myocardial characteristic alterations in remote myocardium at multiple time points, and its prognostic significance after acute ST-segment elevation myocardial infarction (STEMI).Patients were enrolled prospectively and performed CMR at baseline, 30 days, and 6 months. The primary endpoint was major adverse cardiac events (MACE): death, myocardial reinfarction, malignant arrhythmia, and hospitalization for heart failure. Cox proportional hazards regression modeling was analyzed to estimate the correlation between T1 mapping of remote myocardium and MACE in patients with and without microvascular obstruction (MVO).A total of 135 patients (mean age 60.72 years; 12.70% female, median follow-up 510 days) were included, of whom 86 (63.70%) had MVO and 26 (19.26%) with MACE occurred in patients. Native T1 values of remote myocardium changed dynamically. At 1 week and 30 days, T1 values of remote myocardium in the group with MVO were higher than those without MVO (p = 0.030 and p = 0.001, respectively). In multivariable cox regression analysis of 135 patients, native1w T1 (HR 1.03, 95%CI 1.01-1.04, p = 0.002), native30D T1 (HR 1.05, 95%CI 1.03-1.07, p < 0.001) and LGE (HR 1.10, 95%CI 1.05-1.15, p < 0.001) were joint independent predictors of MACE. In multivariable cox regression analysis of 86 patients with MVO, native30D T1 (HR 1.05, 95%CI 1.04-1.07, p < 0.001) and LGE (HR 1.10, 95%CI 1.05-1.15, p < 0.001) were joint independent predictors of MACE.The evolution of native T1 in remote myocardium was associated with the extent of microvascular impairment after reperfusion injury. In patients with MVO, native30D T1 and LGE were joint independent predictors of MACE.© 2023. The Author(s).