The relation between hypointense core, microvascular obstruction and intramyocardial haemorrhage in acute reperfused myocardial infarction assessed by cardiac magnetic resonance imagingReport as inadecuate




The relation between hypointense core, microvascular obstruction and intramyocardial haemorrhage in acute reperfused myocardial infarction assessed by cardiac magnetic resonance imaging - Download this document for free, or read online. Document in PDF available to download.

European Radiology

, Volume 24, Issue 12, pp 3277–3288

First Online: 06 August 2014Received: 11 October 2013Revised: 19 June 2014Accepted: 04 July 2014

Abstract

BackgroundIntramyocardial haemorrhage IMH and microvascular obstruction MVO represent reperfusion injury after reperfused ST-elevation myocardial infarction STEMI with prognostic impact and -hypointense core- HIC appearance in T2-weighted images. We aimed to distinguish between IMH and MVO by using T2-weighted cardiovascular magnetic resonance imaging CMR and analysed influencing factors for IMH development.

Methods and resultsA total of 151 patients with acute STEMI underwent CMR after primary angioplasty. T2-STIR sequences were used to identify HIC, late gadolinium enhancement to visualise MVO and T2-weighted sequences to detect IMH. IMH-IMH patients were compared considering infarct size, myocardial salvage, thrombolysis in myocardial infarction TIMI flow, reperfusion time, ventricular volumes, function and pre-interventional medication. Seventy-six patients 50 % were IMH, 82 54 % demonstrated HIC and 100 66 % MVO. IMH was detectable without HIC in 16 %, without MVO in 5 % and HIC without MVO in 6 %. Multivariable analyses revealed that IMH was associated with significant lower left ventricular ejection fraction and myocardial salvage index, larger left ventricular volume and infarct size. Patients with TIMI flow grade ≤1 before angioplasty demonstrated IMH significantly more often.

ConclusionsIMH is associated with impaired left ventricular function and higher infarct size. T2 and HIC imaging showed moderate agreement for IMH detection. T2 imaging might be the preferred CMR imaging method for comprehensive IMH assessment.

Key Points• Intramyocardial haemorrhage is a common finding in patients with acute reperfused myocardial-infarction.

• T2imaging should be the preferred CMR method for assessment of intramyocardial haemorrhage.

• Intramyocardial haemorrhage can be considered as an important influencing factor on patient’s outcome.

KeywordsCardiac magnetic resonance imaging Acute myocardial infarction Haemorrhage Microvascular obstruction Hypointense core Abbreviations3D-IR-GRE3D inversion recovery gradient echo sequence

AARarea at risk

CMRcardiac magnetic resonance

EDVend-diastolic volume

ESVend-systolic volume

Gd-DTPAgadolinium diethylenetriaminepentaacetic acid

HIChypointense core

IMHintramyocardial haemorrhage

LGElate gadolinium enhancement

LVleft ventricular

MSImyocardial salvage index

MVOmicrovascular obstruction

ORodds ratio

PPCIprimary percutaneous coronary intervention

SAshort-axis

SSFPsteady state free precession

STEMIST-elevation myocardial infarction

T2-STIRT2 short tau inversion recovery sequence

TIMIthrombolysis in myocardial infarction

TEecho time

TRrepetition time

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Author: Diana Kandler - Christian Lücke - Matthias Grothoff - Claudia Andres - Lukas Lehmkuhl - Stefan Nitzsche - Franziska Riese

Source: https://link.springer.com/







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