Myocardial Hemorrhage After Acute Reperfused ST-Segment–Elevation Myocardial Infarction

Abstract

Supplemental Digital Content is available in the text.

Cardiovascular Magnetic Resonance in Acute ST-Segment–Elevation Myocardial Infarction

“…14 The breakdown products of hemoglobin within the myocardium can be detected as a hypo-intense core 39 within the MI zone on T2*-imaging or T2*-mapping (Figures 1 and 2). Of the two approaches, T2*-mapping has been shown to have greater sensitivity for detecting intramyocardial hemorrhage following STEMI when compared to T2-mapping (Table 1).…”

“…The extent of late microvascular obstruction has been reported to peak at 4–12 hours, to remain stable the first 2 days and to reduce in size by day 10 following STEMI. 14 Furthermore, in those patients with microvascular obstruction persisting at one week, Orn and colleagues 49 showed that they were more likely to develop adverse LV remodeling compared to those with microvascular obstruction at day 2 only. On the other hand, the detection of intramyocardial hemorrhage has been shown to peak at day 3, and to reduce in incidence by day 10 following PPCI.…”

“…With the recent availability of native T1, T2, T2* and post-contrast T1-mapping (to derive extracellular volume fraction [ECV] mapping) 11 , more in-depth insights can be obtained into the pathophysiological processes such as the evolution of myocardial edema in the first week post-STEMI 12, 13 , the chronic manifestation of intramyocardial hemorrhage, and its prognostic significance over microvascular obstruction 14, 15 and changes in the remote myocardial interstitial space in those developing adverse LV remodeling 16, 17 following STEMI. In this article, we provide an overview of some of the recent advances in CMR imaging in reperfused STEMI patients, discuss the recent controversies surrounding its use, and explore future applications of CMR in this setting.…”

Coronary Thermodilution Waveforms After Acute Reperfused ST‐Segment–Elevation Myocardial Infarction: Relation to Microvascular Obstruction and Prognosis

“…However, failed myocardial reperfusion, depicted by microvascular obstruction on contrast‐enhanced cardiac magnetic resonance (CMR) imaging, occurs in more than half of these patients,3, 4 implicating an adverse long‐term prognosis 5, 6…”

“…Standard measures of myocardial reperfusion, including TIMI (Thrombolysis in Myocardial Infarction) Myocardial Perfusion Grade and corrected frame count, or ST‐segment resolution on the ECG, lack sensitivity and reproducibility 6, 7, 8, 9. CMR is the reference noninvasive technique for detection of microvascular pathology3, 5, 10; however, CMR is neither feasible acutely nor widely available1 and is not routinely recommended in contemporary practice guidelines 1, 11…”