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Microvascular obstruction following PCI is associated with reperfusion hemorrhage and chronic left ventricular impairment
Journal of Cardiovascular Magnetic Resonance volume 12, Article number: O82 (2010)
Myocardial hemorrhage occurs when severely ischemic myocardium is reperfused and is a potential marker for subsequent LV remodeling. The relationship between reperfusion hemorrhage (RH) and microvascular obstruction (MVO) is poorly understood. Although gross hemorrhage is detectable on T2-weighted imaging, the true incidence of hemorrhagic transformation in acute myocardial infarction is unknown.
To use T2*-mapping as a sensitive CMR technique for the detection of hemorrhage within acutely reperfused infarcts and examine the association with MVO and the impact on LV function.
30 patients were studied who had received PCI following an acute STEMI. Each subject had a CMR within a week of intervention and at 1 year. Hemorrhage was detected with T2* mapping using a black-blood navigator-gated gradient multiecho sequence (TR 17 ms, 7 echoes, TE 2.3 - 16.1 ms). The region of hemorrhage (T2*<20 ms) was compared to the extent of necrosis and microvascular obstruction (MVO) on contrast enhanced sequences.
RH was detected in 17 patients (57%). The areas of hemorrhage and MVO were seen in the same location in all subjects (Figure 1). Acutely hemorrhagic infarcts showed increased end diastolic volume index (94.6 ± 23.7 vs 72.3 ± 15.1 ml, p < 0.01) and reduced ejection fraction (56 ± 14 vs 64 ± 7.8%, p < 0.05) compared to non-hemorrhagic infarcts at 1 year follow-up.
The incidence of RH is more common than previously reported using less sensitive imaging techniques. Hemorrhage and MVO appear in the same distribution suggesting that the two processes are closely related. Hemorrhagic transformation of the infarct might therefore be a potential mechanism for the poor outcome observed in infarcts with MVO.
RH occurs in the same regions as MVO and is associated with poor recovery of function at 1 year follow-up.
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O'Regan, D., Ben, A., Neuwirth, C. et al. Microvascular obstruction following PCI is associated with reperfusion hemorrhage and chronic left ventricular impairment. J Cardiovasc Magn Reson 12, O82 (2010). https://doi.org/10.1186/1532-429X-12-S1-O82
- Acute Myocardial Infarction
- Microvascular Obstruction
- Hemorrhagic Transformation
- Poor Recovery
- Sensitive Imaging