Reperfusion haemorrhage as determined by cardiovascular MRI is a predictor of adverse left ventricular remodelling and markers of late arrhythmic risk

Mather, Adam N; Fairbairn, Timothy A.; Ball, Stephen G.; Greenwood, John P; Plein, Sven

doi:10.1136/hrt.2010.202028

Cited by 140 publications

(147 citation statements)

References 32 publications

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“…Intramyocardial hemorrhage has been widely reported to be associated with larger infarctions and MVO after reperfusion both in animal models (8)(9)(10)(11) and in humans (12)(13)(14). It is important to note that intramyocardial hemorrhage has been shown to be a significant predictor of poor left ventricular (LV) remodeling (15)(16)(17)(18), late arrhythmogenic risk (19), and major adverse cardiovascular events (20).…”

Section: Patient Studiesmentioning

confidence: 99%

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

Kali

Tang²,

Kumar³

et al. 2013

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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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Section: Patient Studiesmentioning

confidence: 99%

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

Kali

Tang²,

Kumar³

et al. 2013

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“…This is in disagreement with previous studies, which found that MVO and IMH were strong predictors of LV remodelling and mortality. 9,28,29 The reason for this discrepancy is likely because cardiac function was assessed by cine MR-imaging an average of seven days after the infarction was induced. This time span is far too short to develop pronounced LV remodelling, and the negative effect of MVO and IMH on LV remodelling has therefore not been fully elucidated in this study.…”

Section: Discussionmentioning

confidence: 99%

“…3,6 Both conditions predict poor outcome, and are independent markers of adverse Left Ventricular (LV) remodelling. [7][8][9] The pathogenesis of ischemic reperfusion injury is complex and remains only partially understood. Still, oxidative stress, inflammation and intracellular Ca 2+ overload are considered to be essential components of ischemia-reperfusion injury.…”

Section: Introductionmentioning

confidence: 99%

Dimethyl Sulfoxide Reduces Microvascular Obstruction and Intramyocardial Hemorrhagein a Porcine Ischemia-Reperfusion Model

Pedersen¹,

Grøndal²,

Andersen³

et al. 2015

Heart Res Open J

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The pathophysiology of reperfusion injury is characterized by release of reactive oxygen species and inflammation. We investigated whether post-ischemic reperfusion with Dimethyl sulfoxide (DMSO), an organic solvent with therapeutic anti-inflammatory and antioxidant capabilities, could diminish or even abrogate the development of MVO and IMH in a porcine myocardial ischemia/reperfusion model. Methods and Results: Myocardial ischemia was induced in 20 pigs by balloon occlusion of the Left anterior descending artery (LAD) for 65 minutes. The pigs were allocated to one-hour reperfusion with DMSO or placebo. Eight days post-injury, IMH, MVO, left ventricular function, and myocardial salvage were assessed by Cardiovascular Magnetic Resonance (CMR) imaging; and IMH and myocardial salvage were also assessed by gross pathology. All pigs in the placebo group (100%) but only 10% of the pigs in the DMSO group had IMH. CMR imaging showed presence of MVO in all placebo-treated pigs (100%) and 88% of the DMSO-treated pig and the MVO size was 45% (p=0.03) smaller in DSMO treated pigs. No difference in myocardial salvage between the placebo and the DMSO group was found by CMR, and pathological investigation and global left ventricular function examination showed no difference between the two study groups. Conclusion: Reperfusion with a DMSO-containing solvent applied during ischemic reperfusion protected against IMH and MVO in a porcine myocardial ischemic/reperfusion model.

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“…This can be detected by CMR and was reported in 25% of patients with STEMI treated successfully by primary PCI. 78 The presence of haemorrhage was an independent predictor of adverse remodelling, as reflected by increased left ventricular (LV) end-systolic volume at 3 months. The importance of interstitial haemorrhage as a predictor of LV remodelling was emphasised by the improvement in the area under the receiver operating characteristic curves from 0.699 to 0.826 when it was added to LV ejection fraction and infarct size in the predictive model.…”

Section: Infarct Size and Myocardial Salvagementioning

confidence: 99%

Almanac 2012: Interventional cardiology

Meier

2013

Revista Portuguesa de Cardiologia (English Edition)

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The field of interventional cardiology continues to progress quickly. The efficacy of percutaneous interventions with newer generation drug-eluting stents has advanced a lot over the last decade. This improvement in stent performance has broadened the level of indication towards more complex interventions such as left main and multivessel PCI. Major improvements continue in the field of medical co-therapy such as antiplatelet therapies (bivalirudin, prasugrel, ticagrelor) and this will further improve outcomes of PCI. The same is true for intravascular imaging such as ultrasound IVUS and optical coherence tomography OCT. However, interventional cardiology has become a rather broad field, also including alcohol septal ablation for hypertrophic obstructive cardiomyopathy, etc. At the moment, the fastest growing area is the structural interventions, especially for aortic valve stenosis (transcatheter aortic valve implantation TAVI) and for mitral regurgitation (mitral clipping). This review covers recent advances in all these different fields of interventional cardiology. PERCUTANEOUS CORONARY INTERVENTION VERSUS MEDICAL TREATMENTPercutaneous coronary intervention (PCI) has guideline recommendations for treatment of ST elevation and non-ST elevation myocardial infarction (MI). 1 However, its role in stable coronary disease has been the subject of reappraisal following publication of the COURAGE trial, which showed that, in patients receiving optimal medical therapy, PCI does not improve cardiovascular outcomes, while incremental benefits for quality of life disappear by 36 months. A more recent meta-analysis of eight trials of optimal medical therapy versus PCI involving 7229 patients bears out the COURAGE conclusions by showing no significant differences between the groups with regard to death (9.1% vs 8.9%), non-fatal MI (8.1% vs 8.9%), unplanned revascularisation (30.7% vs 21.4%) and persistent angina (33% vs 29%).4 Drug-eluting stents (DESs) were used in only a minority of these patients and may have reduced the need for further revascularisation while improving symptomatic responses. Nevertheless, the meta-analysis reinforces contemporary guideline advice for optimal medical treatment as the initial treatment for stable angina.

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Reperfusion haemorrhage as determined by cardiovascular MRI is a predictor of adverse left ventricular remodelling and markers of late arrhythmic risk

Cited by 140 publications

References 32 publications

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

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

Dimethyl Sulfoxide Reduces Microvascular Obstruction and Intramyocardial Hemorrhagein a Porcine Ischemia-Reperfusion Model

Almanac 2012: Interventional cardiology

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