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Poster presentation | Open | Published:

MRI evaluation of the role of No-Reflow in left ventricular remodeling after Acute Myocardial Infarction (AMI)

Purpose

LV remodeling represents the most important negative prognostic factor after myocardial infarction. Aim of the study is to assess by MRI the role of edema, no-reflow and myocardial viability in the remodeling process.

Materials and methods

32 pts with AMI and primary PCI (25 LAD, 3 CX, 4 RCA; 26: TIMI 3, 6: TIMI 2) were studied by MRI to measure end-diastolic (EDV) and end-systolic (ESV) volumes immediately and 1-month later. A >20% increase of EDV and/or ESV was considered indicative of remodeling. Triple IR-FSE for edema evaluation, steady-state free precession cine (FIESTA) for contractile function, fast-gradient echo train (FGRET) for first-pass perfusion study and IR-prep fast GRE for delayed enhancement assessment were obtained. A score for edema, no-reflow and hyperenhancement was calculated in each segment (17-segments LV model) based on number of segments and transmural extension (75%).

Results

14 pts showed remodeling. EDV and ESV increased from 106 ± 30 ml to 153 ± 36 ml and from 60 ± 17 ml to 91 ± 23 ml in pts with remodeling. No-reflow was detected in 26 pts (81%). The scores for edema, no-reflow and hyperenhancement were 4.0 ± 1.6, 2.4 ± 1.1, 3.3 ± 1.6 respectively in pts with remodeling and 2.9 ± 2.2 (p:NS), 1.4 ± 0.9 (p:0.04), 2.6 ± 1.7 (p:NS) respectively in pts without remodeling.

Conclusion

First-pass MRI detects an high incidence of no-reflow after PCI. Its extension was more significantly related to remodeling if compared to edema and necrotic myocardium.

No-reflow assessed by first pass imaging seems to be a stronger predictor of LV remodeling, compared to infarct size, in AMI.

Author information

Correspondence to Carlo Liguori.

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Keywords

  • Acute Myocardial Infarction
  • Acute Myocardial Infarction
  • Myocardial Viability
  • Left Ventricular Remodel
  • Negative Prognostic Factor