Hemorrhagic Myocardial Infarction After Coronary Reperfusion Detected In Vivo by Magnetic Resonance Imaging in Humans: Prevalence and Clinical Implications

Ochiai, Koichi; Shimada, Toshio; Murakami, Yo; Ishibashi, Yutaka; Sano, Kazuya; Kitamura, Jun; Inoue, Shinichi; Murakami, Rinji; Kawamitsu, Hideaki; Sugimura, Kazuro

doi:10.3109/10976649909088337

Cited by 54 publications

(54 citation statements)

References 23 publications

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“…Furthermore, the combination of T 2 -weighted and contrast-enhanced T 1 -weighted sequences were used to detect and discriminate acute from chronic infarct (54) and intramyocardial hemorrhage from MO in patients (Fig. 5) (55). MR imaging with late gadolinium enhancement technique is the gold standard technique for determining the location and extent of myocardial necrosis including no-reflow zone (56).…”

Section: Cellular Injury Gadolinium Imagingmentioning

confidence: 99%

MR imaging in assessing cardiovascular interventions and myocardial injury

Jacquier

Higgins

Saeed

2007

Contrast Media & Molecular

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Performing an MR-guided endovascular intervention requires (1) real-time tracking and guidance of catheters/guide wires to the target, (2) high-resolution images of the target and its surroundings in order to define the extent of the target, (3) performing a therapeutic procedure (delivery of stent or injection of gene or cells) and (4) evaluating the outcome of the therapeutic procedure. The combination of X-ray and MR imaging (XMR) in a single suite was designed for new interventional procedures. MR contrast media can be used to delineate myocardial infarcts and microvascular obstruction, thereby defining the target for local delivery of therapeutic agents under MR-guidance. Iron particles, or gadolinium- or dysprosium-chelates are mixed with the soluble injectates or stem cells in order to track intramyocardial delivery and distribution. Preliminary results show that genes encoded for vascular endothelial and fibroblast growth factor and cells are effective in promoting angiogenesis, arteriogenesis, perfusion and LV function. Angiogenic growth factors, genes and cells administered under MR-guided minimally invasive catheter-based procedures will open up new avenues in treating end-stage ischemic heart disease. The optimum dose of the therapeutic agents, delivery devices and real-time imaging techniques to guide the delivery are currently the subject of ongoing research. The aim of this review is to (1) provide an updated review of experiences using MR imaging to guide transcatheter therapy, (2) address the potential of cardiovascular magnetic resonance (MR) imaging and MR contrast media in assessing myocardial injury at a molecular level and labeling cells and (3) illustrate the applicability of the non-invasive MR imaging in the field of angiogenic therapies through recent clinical and experimental publications.

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Section: Cellular Injury Gadolinium Imagingmentioning

confidence: 99%

MR imaging in assessing cardiovascular interventions and myocardial injury

Jacquier

Higgins

Saeed

2007

Contrast Media & Molecular

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“…Both T2*-weighted and T2-weighted CMR techniques have been used to detect acute reperfusion intramyocardial hemorrhage. [31][32][33][34][35][36]38,39,43 After intramyocardial hemorrhage, oxyhemoglobin in the RBCs extravasated into the myocardial interstitium is slowly converted into paramagnetic forms, such as deoxyhemoglobin and methemoglobin, in the acute phase of myocardial infarction. 1 Our current study has shown that, in the chronic phase of infarction (ie, months after infarction), iron from the extravasated RBCs is externalized and crystallized to form the highly paramagnetic hemosiderin deposits.…”

Section: Detection Of Regional Iron Deposition After Hemorrhagic Infamentioning

confidence: 99%

“…Cine steady-state free precession 37 2 ), T2*-weighted 38,39 (TR=240 milliseconds; 6 TEs=2.6 milliseconds−13.7 milliseconds with ΔTE=2.2 milliseconds, flip angle=10°; BW=355 Hz/pixel; in-plane resolution=1.6×1.6 mm 2 ), and late gadolinium enhancement 40 (LGE; inversion-recovery prepared fast low-angle shot; TR =1 R-R interval; TE=3.32 milliseconds; BW=235 Hz/pixel, 1.6×1.6 mm 2 ) images of contiguous short-axis sections of the LV along with 2-, 3-, and 4-chamber long-axis views of the heart were acquired. Commonly used imaging parameters were slice thickness of 10 mm and number of averages of 1.…”

Section: Patient Selection and Cmr Imaging Studiesmentioning

confidence: 99%

Chronic Manifestation of Postreperfusion Intramyocardial Hemorrhage as Regional Iron Deposition

Kali

Kumar

Cokic

et al. 2013

Circ: Cardiovascular Imaging

102

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Background— Intramyocardial hemorrhage frequently accompanies large reperfused myocardial infarctions. However, its influence on the makeup and the ensuing effect on the infarcted tissue during the chronic phase remain unexplored. Methods and Results— Patients (n=15; 3 women), recruited after successful percutaneous coronary intervention for first segment–elevation myocardial infarction, underwent cardiovascular magnetic resonance imaging on day 3 and month 6 after percutaneous coronary intervention. Patients with hemorrhagic (Hemo+) infarctions, as determined by T2* cardiovascular magnetic resonance on day 3 (n=11), showed persistent T2* losses colocalized with scar tissue on the follow-up scans, suggesting chronic iron deposition. T2* values of Hemo+ territories were significantly higher than nonhemorrhagic (Hemo−) and remote territories ( P <0.001); however, T2* values of nonhemorrhagic (Hemo−) and remote territories were not different ( P =0.51). Canines (n=20) subjected to ischemia-reperfusion injury (n=14) underwent cardiovascular magnetic resonance on days 3 and 56 after ischemia-reperfusion injury. Similarly, sham-operated animals (Shams; n=3) were imaged using cardiovascular magnetic resonance at similar time points. Subsequently, hearts were explanted and imaged ex vivo, and samples of Hemo+, Hemo−, remote, and Sham myocardium were isolated and stained. The extent of iron deposition ([Fe]) within each sample was measured using mass spectrometry. Hemo+ infarcts showed significant T2* losses compared with the other (control) groups ( P <0.001), and Perls stain confirmed localized iron deposition. Mean [Fe] of Hemo+ was nearly an order of magnitude greater than that of the control groups ( P <0.001), but no significant differences were observed among the control groups. A strong linear relationship was observed between log(T2*) and −log([Fe]); R 2 =0.7 and P <0.001. The monoclonal antibody Mac387 stains, along with Perls stains, showed preferential localization of newly recruited macrophages at the site of chronic iron deposition. Conclusions— Hemorrhagic myocardial infarction can lead to iron depositions within the infarct zones, which can be a source of prolonged inflammatory burden in the chronic phase of myocardial infarction.

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“…Cardiac magnetic resonance (MR) imaging based on either T2*-weighted (16,18,(21)(22)(23)(24) or T2-weighted (15,17, Implication for Patient Care n The occurrence of myocardial reperfusion hemorrhage, which has been associated with acute myocardial damage and adverse chronic remodeling, is expected to be more reliably assessed with T2* cardiac MR imaging than with T2-based cardiac MR imaging.…”

Section: Patient Studiesmentioning

confidence: 99%

Detection of Acute Reperfusion Myocardial Hemorrhage with Cardiac MR Imaging: T2 versus T2*

Kali¹,

Tang

Kumar³

et al. 2013

Radiology

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Purpose:To evaluate T2 and T2* changes in acute reperfused hemorrhagic and nonhemorrhagic myocardial infarctions and to determine which technique is more suitable in the detection of intramyocardial hemorrhage at 1.5 T. Materials and Methods:Patient studies were approved by the institutional review board and were HIPAA compliant. Patients (n = 14, three women) with first ST-elevation myocardial infarction underwent cardiac magnetic resonance (MR) imaging 3 days after angioplasty. T2* maps, T2 short inversion time inversion-recovery (STIR) images, and late gadolinium enhancement (LGE) images were acquired. Animal studies were approved by the institutional animal care and use committee. Canines (n = 20) were subjected to ischemia-reperfusion injury, and cardiac MR imaging was performed 5 days after reperfusion. T2* and T2 maps and T2 STIR and LGE images were acquired. Repeated-measures analysis of variance or the Friedman test was used to compare T2 and T2* changes in patients with hemorrhagic infarctions and those with nonhemorrhagic infarctions. Results:Relative to remote myocardium, mean T2* of hemorrhagic infarctions was 54% 6 13 (standard deviation) lower in patients (15.9 msec 6 4.5 vs 35.2 msec 6 2.1, P , .001) and 40% 6 10 lower in canines (23.0 msec 6 4.0 vs 39.3 msec 6 2.5, P , .001). Mean T2* of nonhemorrhagic infarctions was marginally elevated by 6% 6 2.5 (37.8 msec 6 2.5, P = .021) in patients and by 8% 6 5 (44.6 msec 6 4.8, P = .012) in canines. In contrast, mean T2 STIR signal intensity (SI) of both hemorrhagic infarctions and nonhemorrhagic infarctions was higher than that in remote myocardium both in patients (hemorrhagic: 37% 6 19, P , .001; nonhemorrhagic: 78% 6 27, P , .001) and in canines (hemorrhagic: 42% 6 22, P , .001; nonhemorrhagic: 65% 6 22, P , .001). Consistent with STIR SI findings, mean T2 of both hemorrhagic (62.0 msec 6 4.9) and nonhemorrhagic (71.7 msec 6 7.3) infarctions in canines was elevated relative to mean T2 of remote myocardium (52.1 msec 6 4.8) by 18% 6 9 and 38% 6 13, respectively (P , .001 for both). Conclusion

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Hemorrhagic Myocardial Infarction After Coronary Reperfusion Detected In Vivo by Magnetic Resonance Imaging in Humans: Prevalence and Clinical Implications

Cited by 54 publications

References 23 publications

MR imaging in assessing cardiovascular interventions and myocardial injury

MR imaging in assessing cardiovascular interventions and myocardial injury

Chronic Manifestation of Postreperfusion Intramyocardial Hemorrhage as Regional Iron Deposition

Detection of Acute Reperfusion Myocardial Hemorrhage with Cardiac MR Imaging: T2 versus T2*

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