Effect of Microvascular Obstruction and Intramyocardial Hemorrhage by CMR on LV Remodeling and Outcomes After Myocardial Infarction

Hamirani, Yasmin S.; Wong, Andrew; Kramer, Christopher M.; Salerno, Michael

doi:10.1016/j.jcmg.2014.06.012

Cited by 216 publications

(162 citation statements)

References 87 publications

(175 reference statements)

Supporting

Mentioning

138

Contrasting

Unclassified

Order By: Relevance

“…We found a lower mean LVEF in patients with MO compared with the control group, in the initial cardiac MRI as well as in the follow-up. These data are consistent with other studies that emphasize the prognostic value of MO and the association to left ventricular remodeling after acute myocardial infarction (8,9,19,20). The findings of Wong et al (20) suggest MO as a strong predictor for left ventricular function following STEMI.…”

Section: Discussionsupporting

confidence: 90%

Temporal course of microvascular obstruction after myocardial infarction assessed by MRI

Abanador-Kamper

Karamani

Kamper³

et al. 2016

Diagn Interv Radiol

View full text Add to dashboard Cite

M icrovascular obstruction (MO) appears as a no-reflow area due to reperfusion after a prolonged myocardial ischemia. MO can be directly visualized by cardiac magnetic resonance imaging (MRI) (1-4). The exact pathophysiology of MO remains unclear; however, a no-reflow area as a result of capillary obstruction due to myocardial necrosis or distal embolization after primary percutaneous coronary intervention (PCI) is being discussed (5). MO is observed in patients with ST-elevated myocardial infarction (STEMI) and non ST-elevated myocardial infarction (NSTEMI). The fact that MO is observed in both successfully and unsuccessfully reperfused myocardium underlines the hypothesis of myocardial tissue hypoperfusion despite a patent culprit lesion (5, 6). The presence of MO has been associated with an increased risk for left ventricular remodeling, rehospitalization, reinfarction, and death and is therefore a strong prognostic marker (3, 7-10).Some authors distinguished between early and late MO, differentiated by the period between gadolinium injection and image acquisition (9, 11). These studies identified late or persistent MO after 15 minutes as a stronger prognostic factor after acute myocardial infarction (9).There are only a few studies on time-dependent changes of MO, predominantly with animal data. Most of these studies analyzed the extent of MO after reperfusion in the acute phase of myocardial ischemia (2,11,12). Data on long-term course of MO are lacking, so far.The objective of this study was to assess the follow-up of MO in patients after acute myocardial infarction. Methods Study populationWe identified 31 patients with MO after acute myocardial infarction and primary PCI by cardiac MRI. Patients were eligible if they had ST-segment elevation of at least 0. PURPOSEWe aimed to analyze the extent of microvascular obstruction (MO) after the index event compared with the follow-up at a median of three months. METHODSWe identified 31 patients with MO after primary percutaneous coronary intervention of acute myocardial infarction by cardiac magnetic resonance imaging. The initial examination was performed after the index event, and 27 patients had the follow-up exam after a median of three months (interquartile range, 2-4 months). In addition, we examined 10 patients without MO after transmural myocardial infarction, as a control group. RESULTSMO disappeared in 23 of 27 patients (85%) in the follow-up and transformed into transmural late gadolinium enhancement. In patients with persistent MO, mean MO size decreased from 2.25% to 1.25%. In patients with MO, mean infarct size decreased significantly from 20.8% to 14.7% (P < 0.001). In the control group, mean infarct size decreased from 12.7% to 10.5% in the follow-up scan (P = 0.137). CONCLUSIONMO is significantly reduced during the follow-up after acute myocardial infarction.

show abstract

Section: Discussionsupporting

confidence: 90%

Temporal course of microvascular obstruction after myocardial infarction assessed by MRI

Abanador-Kamper

Karamani

Kamper³

et al. 2016

Diagn Interv Radiol

View full text Add to dashboard Cite

show abstract

“…Since we focused on the relationship between the QRS score and MO on CMR imaging in the present study, we did not indicate the relationship between the QRS score and infarct size. In addition, although intramyocardial hemorrhage on T2 imaging is a frequently observed phenomenon after MI associated with the severity of myocardial damage [29], we did not analyze this phenomenon in the present study.…”

Section: Study Limitationsmentioning

confidence: 94%

Relationship between QRS score and microvascular obstruction after acute anterior myocardial infarction

Watanabe

Isobe

Okumura

et al. 2016

Journal of Cardiology

View full text Add to dashboard Cite

show abstract

“…MI size,4, 5 presence of microvascular obstruction (MVO),6, 7 and myocardial salvage8, 9 assessed by cardiovascular magnetic resonance (CMR) performed in the first few days after reperfusion in STEMI patients have all been shown to be strong predictors of adverse left ventricular (LV) remodeling and development of heart failure.…”

Section: Introductionmentioning

confidence: 99%

Automated Extracellular Volume Fraction Mapping Provides Insights Into the Pathophysiology of Left Ventricular Remodeling Post–Reperfused ST‐Elevation Myocardial Infarction

Bulluck

Rosmini

Abdel‐Gadir

et al. 2016

JAHA

View full text Add to dashboard Cite

BackgroundWhether the remote myocardium of reperfused ST‐segment elevation myocardial infarction (STEMI) patients plays a part in adverse left ventricular (LV) remodeling remains unclear. We aimed to use automated extracellular volume fraction (ECV) mapping to investigate whether changes in the ECV of the remote (ECVR emote) and infarcted myocardium (ECVI nfarct) impacted LV remodeling.Methods and ResultsForty‐eight of 50 prospectively recruited reperfused STEMI patients completed a cardiovascular magnetic resonance at 4±2 days and 40 had a follow‐up scan at 5±2 months. Twenty healthy volunteers served as controls. Mean segmental values for native T1, T2, and ECV were obtained. Adverse LV remodeling was defined as ≥20% increase in LV end‐diastolic volume. ECVR emote was higher on the acute scan when compared to control (27.9±2.1% vs 26.4±2.1%; P=0.01). Eight patients developed adverse LV remodeling and had higher ECVR emote acutely (29.5±1.4% vs 27.4±2.0%; P=0.01) and remained higher at follow‐up (28.6±1.5% vs 26.6±2.1%; P=0.02) compared to those without. Patients with a higher ECVR emote and a lower myocardial salvage index (MSI) acutely were significantly associated with adverse LV remodeling, independent of T1Remote, T1Core and microvascular obstruction, whereas a higher ECVI nfarct was significantly associated with worse wall motion recovery.Conclusions ECVR emote was increased acutely in reperfused STEMI patients. Those with adverse LV remodeling had higher ECVR emote acutely, and this remained higher at follow‐up than those without adverse LV remodeling. A higher ECVR emote and a lower MSI acutely were significantly associated with adverse LV remodeling whereas segments with higher ECVI nfarct were less likely to recover wall motion.

show abstract

Effect of Microvascular Obstruction and Intramyocardial Hemorrhage by CMR on LV Remodeling and Outcomes After Myocardial Infarction

Cited by 216 publications

References 87 publications

Temporal course of microvascular obstruction after myocardial infarction assessed by MRI

Temporal course of microvascular obstruction after myocardial infarction assessed by MRI

Relationship between QRS score and microvascular obstruction after acute anterior myocardial infarction

Automated Extracellular Volume Fraction Mapping Provides Insights Into the Pathophysiology of Left Ventricular Remodeling Post–Reperfused ST‐Elevation Myocardial Infarction

Contact Info

Product

Resources

About