Intramyocardial haemorrhage after acute myocardial infarction

Abstract

In patients with acute myocardial infarction (AMI), the guideline-recommended treatment is mechanical revascularization by percutaneous coronary intervention (PCI), which is effective at reducing mortality. However, a substantial proportion of patients with AMI develop chronic cardiac failure owing to poor restoration of microvascular function and myocardial perfusion, despite restoration of epicardial vessel patency. This occurrence is called the 'no-reflow' phenomenon. Although pathological and clinical observations initially seemed to support the hypothesis that no-reflow was the result of microvascular obstruction, irreversible microvascular injury and subsequent intramyocardial haemorrhage are now also thought to be important factors in this process. Intramyocardial haemorrhage shares several pathophysiological features with the haemorrhagic transformation that occurs after ischaemic stroke. Understanding of the role of intramyocardial haemorrhage in the no-reflow phenomenon and myocardial injury is crucial to the development of new therapeutic strategies to treat AMI. In this Review, we provide a comprehensive overview of the pathogenesis and clinical relevance of intramyocardial haemorrhage, and discuss diagnostic options and future therapeutic strategies.

Risk stratification by cardiac magnetic resonance imaging after ST-elevation myocardial infarction

“…Reperfusion of severely damaged microvasculature might be followed by erythrocyte extravasation within the infarct core [46]. T1-, T2-, and T2 Ã -weighted sequences are able to detect these regions of intramyocardial hemorrhage (IMH) [47][48][49][50] ( Fig.…”

Triptolide Attenuates Myocardial Ischemia/Reperfusion Injuries in Rats by Inducing the Activation of Nrf2/HO-1 Defense Pathway

“…Myocardial ischemia/reperfusion (I/R) is a pathological condition characterized by an initial occlusion of blood supply to heart followed by the subsequent restoration of perfusion and concomitant reoxygenation [2,3]. Timely restoration of epicardial vessel patency allowing myocardial reperfusion is proposed to explain any survival advantage seen with percutaneous coronary intervention or thrombolysic treatment [4]. However, reperfusion injury after acute ischemia generates myocardial injuries similar to or even worse than pure ischemia as reported before [5].…”

The Coronary Circulation as a Target of Cardioprotection

“…123,124 No-reflow and hemorrhage carry an adverse prognosis for patients with reperfused myocardial infarction. [124][125][126] The above manifestations of coronary vascular injury by myocardial ischemia/reperfusion are attenuated by local ischemic pre-and postconditioning, as well as by remote ischemic conditioning and by various cardioprotective drugs and interventions. However, not for every manifestation of coronary vascular injury information is available for every form of cardioprotection.…”