Clinical associations of microvascular obstruction and intramyocardial hemorrhage on cardiovascular magnetic resonance in patients with acute ST segment elevation myocardial infarction (STEMI)

Abstract

Acute myocardial infarction (AMI) is recognized as being a life-threatening event. Both microvascular obstruction (MVO) and intramyocardial hemorrhage (IMH) have been recognized as poor prognostic factors in myocardial infarct (MI) since they adversely affect left ventricular remodeling. MVO refers to small vessels changes that prevent adequate tissue perfusion despite revascularization whereas IMH is a severe form of MVO. A limited number of studies have demonstrated the segmental intervention time and the clinical factors in the presence of MVO and IMH. Therefore, we aimed in this study to determine the correlations of the intervention-associated and clinical indexes with malignant cardiovascular magnetic resonance (CMR) signs in patients with AMI.Sixty-three patients with STEMI who underwent primary percutaneous coronary intervention (PPCI) within 12 hours were included in this study. A 3.0-T CMR scan was prescribed, and the subsequent image analysis was conducted by researchers blinded to the clinical index results. Late-gadolinium enhancement (LGE) and T2∗ sequences were mainly used for MVO and IMH identification and quantification.Patients exhibiting both MVO and IMH had the highest level of LGE (P < .001) and were significantly more frequently assigned to a pre-PPCI thrombolysis in myocardial infarction (TIMI) flow class of 0 (n=25, 89.3%). The MVO size correlated positively with the IMH size (r = 0.81, P < .01). A pre-PPCI TIMI flow class of 0 was found to reliably predict the presence of IMH (P < .001). Patients who received the intervention 4 to 6 hours after MI onset were more likely to exhibit MVO and IMH, although this trend was not statistically significant.We showed in our study that both MVO and IMH correlated with the degree of AMI and the pre-PPCI coronary flow, and both tended to occur more frequently in cases involving an interval of 4 to 6 hours between the onset of MI and the intervention. CMR is a reliable method for assessing MVO and IMH and its imaging features following gadolinium administration are characteristic. These findings stress the importance of using CMR in evaluating and improving the outcome of the medical management.

Efficacy of postprocedural anticoagulation after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction

“…CMR is uniquely suited to provide important mechanistic and pathophysiological information on infarct size, MVO, and intramyocardial hemorrhage. [3,4] To the authors’ knowledge, this is the first post-hoc analysis of randomized study to evaluate the impact of postprocedural anticoagulation on infarct size, LVEF, and LV remodeling in patients with STEMI undergoing primary PCI by using CMR and 2D-echocardiography. However, several limitations of the study should be emphasized.…”

“…These additional assessed parameters, primarily microvascular obstruction (MVO), but also myocardial infarct sizing provide strong prognostic information that is incremental to clinical, biomarker, electrocardiographic, and angiographic risk markers. [3,4] LVEF is the classical surrogate functional parameter, because it has been clearly associated with long-term morbidity and mortality after STEMI. [5] In addition, postinfarction LV remodeling has been usually reported to have an impaired prognosis, more often developing into clinical heart failure and resulting in increased mortality.…”

Effect of intramyocardial haemorrhage on structural and functional echocardiographic parameters of myocardium after ST-segment elevation myocardial infarction with

“…Если МВО относится к общепризнанным предикторам патологического ремоделирования и прогрессирования сердечной недостаточности, то мнения о ГПМ противоречивы [5][6][7][8][9]. Согласно метаанализу, включающему 9 исследований, возникновение ГПМ рассматривается как прогностически более неблагоприятный фактор, который ассоциирован со снижением сократительной функции и патологическим ремоделированием миокарда.…”

Phenomenons of microvascular injury in primary myocardial infarction with ST-segment elevation

“…распространенность ГПМ составила 50%, а МВО была визуализирована в 66% случаев [4]. При этом описана взаимосвязь наличия МВО и ГПМ [2][3][4]12]. По нашим данным, сочетание МВО и ГПМ встречалось часто -в 29,8% случаев, однако различия между группами не были статистически значимыми.…”

“…Проведенные исследования продемонстрировали, что реперфузионная терапия способна приводить к эффекту, совершенно противоположному ожидаемому, вызывая развитие реперфузионно/ишемического повреждения [2]. Одним из значимых компонентов реперфузионной травмы является поражение микроциркуляторного русла, состоящего из двух феноменов: микроваскулярной обструкции (МВО), также известной как феномен no-reflow, и геморрагического пропитывания миокарда (ГПМ) [3][4][5].…”