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. 2016 Oct;9(10):e004940.
doi: 10.1161/CIRCIMAGING.116.004940.

Residual Myocardial Iron Following Intramyocardial Hemorrhage During the Convalescent Phase of Reperfused ST-Segment-Elevation Myocardial Infarction and Adverse Left Ventricular Remodeling

Heerajnarain Bulluck  1 , Stefania Rosmini  1 , Amna Abdel-Gadir  1 , Steven K White  1 , Anish N Bhuva  1 , Thomas A Treibel  1 , Marianna Fontana  1 , Manish Ramlall  1 , Ashraf Hamarneh  1 , Alex Sirker  1 , Anna S Herrey  1 , Charlotte Manisty  1 , Derek M Yellon  1 , Peter Kellman  1 , James C Moon  1 , Derek J Hausenloy  2
Affiliations

Residual Myocardial Iron Following Intramyocardial Hemorrhage During the Convalescent Phase of Reperfused ST-Segment-Elevation Myocardial Infarction and Adverse Left Ventricular Remodeling

Heerajnarain Bulluck et al. Circ Cardiovasc Imaging. 2016 Oct.

Abstract

Background: The presence of intramyocardial hemorrhage (IMH) in ST-segment-elevation myocardial infarction patients reperfused by primary percutaneous coronary intervention has been associated with residual myocardial iron at follow-up, and its impact on adverse left ventricular (LV) remodeling is incompletely understood and is investigated here.

Methods and results: Forty-eight ST-segment-elevation myocardial infarction patients underwent cardiovascular magnetic resonance at 4±2 days post primary percutaneous coronary intervention, of whom 40 had a follow-up scan at 5±2 months. Native T1, T2, and T2* maps were acquired. Eight out of 40 (20%) patients developed adverse LV remodeling. A subset of 28 patients had matching T2* maps, of which 15/28 patients (54%) had IMH. Eighteen of 28 (64%) patients had microvascular obstruction on the acute scan, of whom 15/18 (83%) patients had microvascular obstruction with IMH. On the follow-up scan, 13/15 patients (87%) had evidence of residual iron within the infarct zone. Patients with residual iron had higher T2 in the infarct zone surrounding the residual iron when compared with those without. In patients with adverse LV remodeling, T2 in the infarct zone surrounding the residual iron was also higher than in those without (60 [54-64] ms versus 53 [51-56] ms; P=0.025). Acute myocardial infarct size, extent of microvascular obstruction, and IMH correlated with the change in LV end-diastolic volume (Pearson's rho of 0.64, 0.59, and 0.66, respectively; P=0.18 and 0.62, respectively, for correlation coefficient comparison) and performed equally well on receiver operating characteristic curve for predicting adverse LV remodeling (area under the curve: 0.99, 0.94, and 0.95, respectively; P=0.19 for receiver operating characteristic curve comparison).

Conclusions: The majority of ST-segment-elevation myocardial infarction patients with IMH had residual myocardial iron at follow-up. This was associated with persistently elevated T2 values in the surrounding infarct tissue and adverse LV remodeling. IMH and residual myocardial iron may be potential therapeutic targets for preventing adverse LV remodeling in reperfused ST-segment-elevation myocardial infarction patients.

Keywords: ST-segment–; T2 mapping; T2* mapping; elevation myocardial infarction; intramyocardial hemorrhage; residual myocardial iron.

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Figures

Figure 1.
Figure 1.
Basal left ventricular (LV) short axis of a patient with an acute inferior myocardial infarction (MI) depicting microvascular obstruction (MVO) on late gadolinium enhancement (LGE) scans with corresponding hypointense cores (red arrows) on the basal LV short axis T1, T2, and T2* maps and the follow-up scan with corresponding maps and areas of residual myocardial iron on the T2* map.
Figure 2.
Figure 2.
Method used to detect the area of high T2 (T2Infarct) around the area of residual myocardial iron (T2Core) and the remote myocardium (T2Remote) using a threshold of 2 standard deviation (SD) from the remote myocardium. LGE indicates late gadolinium enhancement.
Figure 3.
Figure 3.
Box plots of T1 (A) and T2 (B) values of the core, infarct, and remote myocardium in patients with and without residual myocardial iron.
Figure 4.
Figure 4.
Examples of 3 patients (A, B, and C) with acute and follow-up scans and the red arrows showing areas of microvascular obstruction (MVO), intramyocardial hemorrhage (IMH), and residual myocardial iron and the black arrows showing areas of hyperenhancement on the T2 maps. LGE indicates late gadolinium enhancement.
Figure 5.
Figure 5.
A, T2 values in the infarct zone in patients with and without residual myocardial iron. B, Change in end-diastolic volume (EDV) in patients without adverse left ventricular (LV) remodeling and with or without residual myocardial iron.
See this image and copyright information in PMC

Comment in

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