OBJECTIVES: To investigate the clinical implications of microvascular obstruction (MVO) and intramyocardial haemorrhage (IMH) in acute myocardial infarction (AMI). METHODS: Ninety patients with a first AMI undergoing primary percutaneous coronary intervention (PCI) were studied. T2-weighted, cine and late gadolinium-enhanced cardiovascular magnetic resonance imaging was performed at 5 ± 2 and 103 ± 11 days. Patients were categorised into three groups based on the presence or absence of MVO and IMH. RESULTS: MVO was observed in 54% and IMH in 43% of patients, and correlated significantly (r = 0.8, p < 0.001). Pre-PCI thrombolysis in myocardial infarction 3 flow was only observed in MVO(-)/IMH(-) patients. Infarct size and impairment of systolic function were largest in MVO(+)/IMH(+) patients (n = 39, 23 ± 9% and 47 ± 7%), smallest in MVO(-)/IMH(-) patients (n = 41, 8 ± 8% and 55 ± 8%) and intermediate in MVO(+)/IMH(-) patients (n = 10, 16 ± 7% and 51 ± 6%, p < 0.001). LVEF increased in all three subgroups at follow-up, but remained intermediate in MVO(+)/IMH(-) and was lowest in MVO(+)/IMH(+) patients. Using random intercept model analysis, only infarct size was an independent predictor for adverse LV remodelling. CONCLUSIONS: Intramyocardial haemorrhage and microvascular obstruction are strongly related. Pre-PCI TIMI 3 flow is less frequently observed in patients with MVO and IMH. Only infarct size was an independent predictor of LV remodelling.
OBJECTIVES: To investigate the clinical implications of microvascular obstruction (MVO) and intramyocardial haemorrhage (IMH) in acute myocardial infarction (AMI). METHODS: Ninety patients with a first AMI undergoing primary percutaneous coronary intervention (PCI) were studied. T2-weighted, cine and late gadolinium-enhanced cardiovascular magnetic resonance imaging was performed at 5 ± 2 and 103 ± 11 days. Patients were categorised into three groups based on the presence or absence of MVO and IMH. RESULTS:MVO was observed in 54% and IMH in 43% of patients, and correlated significantly (r = 0.8, p < 0.001). Pre-PCI thrombolysis in myocardial infarction 3 flow was only observed in MVO(-)/IMH(-) patients. Infarct size and impairment of systolic function were largest in MVO(+)/IMH(+) patients (n = 39, 23 ± 9% and 47 ± 7%), smallest in MVO(-)/IMH(-) patients (n = 41, 8 ± 8% and 55 ± 8%) and intermediate in MVO(+)/IMH(-) patients (n = 10, 16 ± 7% and 51 ± 6%, p < 0.001). LVEF increased in all three subgroups at follow-up, but remained intermediate in MVO(+)/IMH(-) and was lowest in MVO(+)/IMH(+) patients. Using random intercept model analysis, only infarct size was an independent predictor for adverse LV remodelling. CONCLUSIONS:Intramyocardial haemorrhage and microvascular obstruction are strongly related. Pre-PCI TIMI 3 flow is less frequently observed in patients with MVO and IMH. Only infarct size was an independent predictor of LV remodelling.
Authors: Kristian Thygesen; Joseph S Alpert; Harvey D White; Allan S Jaffe; Fred S Apple; Marcello Galvani; Hugo A Katus; L Kristin Newby; Jan Ravkilde; Bernard Chaitman; Peter M Clemmensen; Mikael Dellborg; Hanoch Hod; Pekka Porela; Richard Underwood; Jeroen J Bax; George A Beller; Robert Bonow; Ernst E Van der Wall; Jean-Pierre Bassand; William Wijns; T Bruce Ferguson; Philippe G Steg; Barry F Uretsky; David O Williams; Paul W Armstrong; Elliott M Antman; Keith A Fox; Christian W Hamm; E Magnus Ohman; Maarten L Simoons; Philip A Poole-Wilson; Enrique P Gurfinkel; José-Luis Lopez-Sendon; Prem Pais; Shanti Mendis; Jun-Ren Zhu; Lars C Wallentin; Francisco Fernández-Avilés; Kim M Fox; Alexander N Parkhomenko; Silvia G Priori; Michal Tendera; Liisa-Maria Voipio-Pulkki; Alec Vahanian; A John Camm; Raffaele De Caterina; Veronica Dean; Kenneth Dickstein; Gerasimos Filippatos; Christian Funck-Brentano; Irene Hellemans; Steen Dalby Kristensen; Keith McGregor; Udo Sechtem; Sigmund Silber; Michal Tendera; Petr Widimsky; José Luis Zamorano; Joao Morais; Sorin Brener; Robert Harrington; David Morrow; Michael Lim; Marco A Martinez-Rios; Steve Steinhubl; Glen N Levine; W Brian Gibler; David Goff; Marco Tubaro; Darek Dudek; Nawwar Al-Attar Journal: Circulation Date: 2007-10-19 Impact factor: 29.690
Authors: Michael D Shapiro; Koen Nieman; Khurram Nasir; Cesar H Nomura; Ammar Sarwar; Maros Ferencik; Suhny Abbara; Udo Hoffmann; Udo Hoffman; Herman K Gold; Ik-Kyung Jang; Thomas J Brady; Ricardo C Cury Journal: Am J Cardiol Date: 2007-06-04 Impact factor: 2.778
Authors: Hernán Mejía-Rentería; Nina van der Hoeven; Tim P van de Hoef; Julius Heemelaar; Nicola Ryan; Amir Lerman; Niels van Royen; Javier Escaned Journal: Int J Cardiovasc Imaging Date: 2017-05-13 Impact factor: 2.357
Authors: Ryanne P Betgem; Guus A de Waard; Robin Nijveldt; Aernout M Beek; Javier Escaned; Niels van Royen Journal: Nat Rev Cardiol Date: 2014-11-18 Impact factor: 32.419
Authors: Maria Ferré-Vallverdú; Elena Sánchez-Lacuesta; Diego Plaza-López; José Luis Díez-Gil; Pilar Sepúlveda-Sanchis; Carolina Gil-Cayuela; Alicia Maceira-Gonzalez; Vicente Miró-Palau; Anastasio Montero-Argudo; Luis Martínez-Dolz; Begoña Igual-Muñoz Journal: Int J Cardiovasc Imaging Date: 2021-01-13 Impact factor: 2.357
Authors: Martijn W Smulders; Sebastiaan C A M Bekkers; Han W Kim; Lowie M R Van Assche; Michele A Parker; Raymond J Kim Journal: JACC Cardiovasc Imaging Date: 2015-05-14