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Impact of intramyocardial hemorrage on LV remodeling after ST-elevation myocardial infarction

Background

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.

Methods

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.

Results

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.

Conclusions

Presence of IMH after STEMI assessed by T2* CMR predicts LV adverse remodeling.

Funding

Research Grant from the french Society of cardiology (SFC)

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Correspondence to Marc Sirol.

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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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Sirol, M., Gzara, H., Logeart, D. et al. Impact of intramyocardial hemorrage on LV remodeling after ST-elevation myocardial infarction. J Cardiovasc Magn Reson 16, P103 (2014). https://doi.org/10.1186/1532-429X-16-S1-P103

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Keywords

  • Left Ventricle
  • Infarct Size
  • Late Gadolinium Enhancement
  • Microvascular Obstruction
  • Left Ventricle Ejection Fraction