Clinical implications of microvascular obstruction and intramyocardial haemorrhage in acute myocardial infarction using cardiovascular magnetic resonance imaging

Sebastiaan C. A. M. Bekkers*, Martijn W. Smulders, Valeria Lima Passos, Tim Leiner, Johannes Waltenberger, Anton P. M. Gorgels, Simon Schalla

*Corresponding author for this work

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Abstract

To investigate the clinical implications of microvascular obstruction (MVO) and intramyocardial haemorrhage (IMH) in acute myocardial infarction (AMI). Ninety patients with a first AMI undergoing primary percutaneous coronary intervention (PCI) were studied. T2-weighted, cine and late gadolinium-enhanced cardiovascular magnetic resonance imaging was performed at 5 +/- 2 and 103 +/- 11 days. Patients were categorised into three groups based on the presence or absence of MVO and IMH. MVO was observed in 54% and IMH in 43% of patients, and correlated significantly (r = 0.8, p <0.001). Pre-PCI thrombolysis in myocardial infarction 3 flow was only observed in MVO(-)/IMH(-) patients. Infarct size and impairment of systolic function were largest in MVO(+)/IMH(+) patients (n = 39, 23 +/- 9% and 47 +/- 7%), smallest in MVO(-)/IMH(-) patients (n = 41, 8 +/- 8% and 55 +/- 8%) and intermediate in MVO(+)/IMH(-) patients (n = 10, 16 +/- 7% and 51 +/- 6%, p <0.001). LVEF increased in all three subgroups at follow-up, but remained intermediate in MVO(+)/IMH(-) and was lowest in MVO(+)/IMH(+) patients. Using random intercept model analysis, only infarct size was an independent predictor for adverse LV remodelling. Intramyocardial haemorrhage and microvascular obstruction are strongly related. Pre-PCI TIMI 3 flow is less frequently observed in patients with MVO and IMH. Only infarct size was an independent predictor of LV remodelling.
Original languageEnglish
Pages (from-to)2572-2578
JournalEuropean Radiology
Volume20
Issue number11
DOIs
Publication statusPublished - Nov 2010

Keywords

  • Myocardial infarction
  • Intramyocardial haemorrhage
  • Microvascular obstruction
  • Magnetic resonance imaging
  • Ventricular remodelling

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