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. 2010 Nov;20(11):2572-8.
doi: 10.1007/s00330-010-1849-9. Epub 2010 Jun 26.

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

Sebastiaan C A M Bekkers  1 , Martijn W Smulders, Valéria Lima Passos, Tim Leiner, Johannes Waltenberger, Anton P M Gorgels, Simon Schalla
Affiliations

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

Sebastiaan C A M Bekkers et al. Eur Radiol. 2010 Nov.

Abstract

Objectives: To investigate the clinical implications of microvascular obstruction (MVO) and intramyocardial haemorrhage (IMH) in acute myocardial infarction (AMI).

Methods: 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.

Results: 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.

Conclusions: 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.

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Figures

Fig. 1
Fig. 1
Correlation between IMH and MVO. a Original scale values. b Log transformed values. A good linear correlation is seen between MVO and IMH (r = 0.86, p < 0.001). Open circles indicate observed values and stars indicate predicted values in the MVO(+)/IMH(-) group. Note that most of the predicted values are within the lower range of observed values
Fig. 2
Fig. 2
Magnetic resonance image examples from each patient group. Top row (a, b): MVO(−)/IMH(−) patient; middle row (c, d): MVO(+)/IMH(−) patient; bottom row (e, f): MVO(+)/(IMH(+) patient. T2-weighted images are shown on the left (a, c, e) and corresponding late gadolinium-enhanced images on the right (b, d, f). Oedema and infarct border zones are indicated by arrowheads and IMH and MVO by asterisks
Fig. 3
Fig. 3
Area at risk (AAR) and infarct size (IS). AAR (grey bars) and IS (white bars) represented as percentages of LV mass for each patient group. The MVO(+)/IMH(−) group represents an intermediate group. Myocardial salvage is the difference between AAR and IS
Fig. 4
Fig. 4
Left ventricular ejection fraction (LVEF) at baseline and follow-up. LVEF significantly increased in all three groups from baseline (grey bars) to follow-up CMR (white bars), but remained intermediate in the MVO(+)/IMH(−) group
See this image and copyright information in PMC

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