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  • Oral presentation
  • Open Access

Impact of myocardial hemorrhage on left ventricular function and remodeling in patients with reperfused acute myocardial infarction

  • 1,
  • 1,
  • 1,
  • 1,
  • 1,
  • 1 and
  • 1
Journal of Cardiovascular Magnetic Resonance200911 (Suppl 1) :O30

https://doi.org/10.1186/1532-429X-11-S1-O30

  • Published:

Keywords

  • Left Ventricular Ejection Fraction
  • Infarct Size
  • Left Ventricular Volume
  • Microvascular Obstruction
  • Cine Magnetic Resonance Imaging

Background

Myocardial hemorrhage is a common complication following reperfusion of ST-segment-elevation acute myocardial infarction (MI). Although its presence is clearly related to infarct size, at present it is unknown whether post-reperfusion hemorrhage affects left ventricular (LV) remodeling. Magnetic resonance imaging (MRI) can be used to identify myocardial infarction, myocardial hemorrhage and microvascular obstruction (MVO), as well as measure LV volumes, function and mass.

Methods and results

Ninety-eight patients (14 females, 84 males, mean age: 57.7 years) with MI reperfused with percutaneous coronary intervention (PCI) were studied in the first week and at 4 months after the event. T2-weighted MRI was used to differentiate between hemorrhagic (i.e., hypo-intense core) and non-hemorrhagic infarcts (i.e., hyper-intense core). MVO and infarct size were determined on contrast-enhanced MRI, while cine MRI was used to quantify LV volumes, mass and function. Twenty-four patients (25%) presented with a hemorrhagic MI. In the acute phase, presence of myocardial hemorrhage was related to larger LV end-diastolic and end-systolic volumes and infarct transmurality, lower LV ejection fraction as well as lower systolic wall thickening in the infarcted myocardium (all p-values < 0.001). Infarct size, size of area at risk and size of MVO were significantly larger in patients with hermorrhagic MI. At 4 months, a significant improvement in LV ejection fraction in patients with non-hemorrhagic MI was seen (baseline: 49.3 ± 7.9% vs. 4 months: 52.9 ± 8.1%; p < 0.01). LV ejection fraction did, however, not improve in patients with hemorrhagic MI (baseline: 42.8 ± 6.5% vs. 4 months: 41.9 ± 8.5%; p = 0.68). Multivariate analysis showed myocardial hemorrhage to be an independent predictor of adverse LV remodeling at 4 months (defined as an increase in LV end-systolic volume). This pattern was independent of initial infarct size (See Table 1).
Table 1

Results of multiple linear regression of left ventricular remodeling

Predictors of end point

95% CI

R2

F value

p value

Hemorrhagic MI

0.15–0.31

0.17

20.19

<0.001

Infarct size at baseline

20.8–27.7

0.16

18.11

0.001

Microvascular obstruction

5.0–9.3

0.12

13.13

0.001

Maximum troponin I

91.9–142.6

0.10

10.75

0.001

Size of area at risk

37.0–46.5

0.09

9.12

0.003

LV mass at baseline

118.6–131.4

0.02

2.31

0.132

Percent MI transmurality

78.6–87.2

0.03

3.39

0.068

Infarct location

0.37–0.58

<0.01

0.41

0.892

Time to PCI

241.1–305.6

<0.01

0.02

0.874

Conclusion

Myocardial hemorrhage, the presence of which can easily be detected with T2-weighted MRI, is a frequent complication after successful myocardial reperfusion, and an independent predictor of adverse LV remodeling regardless of initial infarct size.

Authors’ Affiliations

(1)
University Hospitals Leuven, Leuven, Belgium

Copyright

© Ganame et al; licensee BioMed Central Ltd. 2009

This article is published under license to BioMed Central Ltd.

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