TY - JOUR
T1 - Clinical implications of microvascular obstruction and intramyocardial haemorrhage in acute myocardial infarction using cardiovascular magnetic resonance imaging
AU - Bekkers, Sebastiaan C. A. M.
AU - Smulders, Martijn W.
AU - Passos, Valeria Lima
AU - Leiner, Tim
AU - Waltenberger, Johannes
AU - Gorgels, Anton P. M.
AU - Schalla, Simon
PY - 2010/11
Y1 - 2010/11
N2 - 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.
AB - 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.
KW - Myocardial infarction
KW - Intramyocardial haemorrhage
KW - Microvascular obstruction
KW - Magnetic resonance imaging
KW - Ventricular remodelling
U2 - 10.1007/s00330-010-1849-9
DO - 10.1007/s00330-010-1849-9
M3 - Article
C2 - 20577881
SN - 0938-7994
VL - 20
SP - 2572
EP - 2578
JO - European Radiology
JF - European Radiology
IS - 11
ER -