Impact of intramyocardial hemorrage on LV remodeling after ST-elevation myocardial infarction
© Sirol et al.; licensee BioMed Central Ltd. 2014
Published: 16 January 2014
Left ventricle (LV) remodeling associated with lower LV ejection fraction after successfully treated ST-elevation myocardial infarction (STEMI) may occur in some patients. We investigated the prognostic value of intramyocardial hemorrhage (IMH) as assessed by T2* images beyond a comprehensive CMR assessment with late gadolinium enhancement (LGE) imaging including microvascular obstruction (MVO) evaluation.
A total of 110 patients with STEMI were prospectively recruited and were examined with CMR at Day 4 ± 2 and Month 6 after reperfusion for measurement of LV end-diastolic (EDV) and end-systolic (ESV) volumes, LV ejection fraction (LVEF) infarct size (IS) and presence and extent of MVO and IMH. Adverse remodeling was defined as dilated left ventricular end-systolic volume indexes (EDV) at 6 months CMR.
All patients were analysed. 41 patients (45%) presented with Anterior AMI, 26 with Lateral (23%) and 29 with Inferior MI (32%). Mean age was 54 +/- 12 y.o (75% male). Mean delay for reperfusion therapy was 115 +/- 100 min. LV remodelling was observed in 39 patients (36%). Despite identical EDV, patients with LV remodelling had lower LVEF at baseline (45% +/- 7 vs 51 +/- 8, p < 0.01), a bigger IS (42 g +/- 20 vs 32 +/- 20; p < 0.01) and MVO extent (p < 0.01). By multivariate analysis, IMH (OR = 2.8[1.3-6.0]) and IS (OR = 3.2[1.8-12.5]) were identified as independent predictors of LV remodelling.
Presence of IMH after STEMI assessed by T2* CMR predicts LV adverse remodeling.
Research Grant from the french Society of cardiology (SFC)
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