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The relation between hypointense core, microvascular obstruction and intramyocardial haemorrhage in acute reperfused myocardial infarction assessed by cardiac magnetic resonance imaging

BACKGROUND: Intramyocardial haemorrhage (IMH) and microvascular obstruction (MVO) represent reperfusion injury after reperfused ST-elevation myocardial infarction (STEMI) with prognostic impact and “hypointense core” (HIC) appearance in T(2)-weighted images. We aimed to distinguish between IMH and M...

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Autores principales: Kandler, Diana, Lücke, Christian, Grothoff, Matthias, Andres, Claudia, Lehmkuhl, Lukas, Nitzsche, Stefan, Riese, Franziska, Mende, Meinhard, de Waha, Suzanne, Desch, Steffen, Lurz, Philipp, Eitel, Ingo, Gutberlet, Matthias
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4231283/
https://www.ncbi.nlm.nih.gov/pubmed/25097126
http://dx.doi.org/10.1007/s00330-014-3318-3
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author Kandler, Diana
Lücke, Christian
Grothoff, Matthias
Andres, Claudia
Lehmkuhl, Lukas
Nitzsche, Stefan
Riese, Franziska
Mende, Meinhard
de Waha, Suzanne
Desch, Steffen
Lurz, Philipp
Eitel, Ingo
Gutberlet, Matthias
author_facet Kandler, Diana
Lücke, Christian
Grothoff, Matthias
Andres, Claudia
Lehmkuhl, Lukas
Nitzsche, Stefan
Riese, Franziska
Mende, Meinhard
de Waha, Suzanne
Desch, Steffen
Lurz, Philipp
Eitel, Ingo
Gutberlet, Matthias
author_sort Kandler, Diana
collection PubMed
description BACKGROUND: Intramyocardial haemorrhage (IMH) and microvascular obstruction (MVO) represent reperfusion injury after reperfused ST-elevation myocardial infarction (STEMI) with prognostic impact and “hypointense core” (HIC) appearance in T(2)-weighted images. We aimed to distinguish between IMH and MVO by using T(2) (*)-weighted cardiovascular magnetic resonance imaging (CMR) and analysed influencing factors for IMH development. METHODS AND RESULTS: A total of 151 patients with acute STEMI underwent CMR after primary angioplasty. T(2)-STIR sequences were used to identify HIC, late gadolinium enhancement to visualise MVO and T(2) (*)-weighted sequences to detect IMH. IMH(+)/IMH(−) patients were compared considering infarct size, myocardial salvage, thrombolysis in myocardial infarction (TIMI) flow, reperfusion time, ventricular volumes, function and pre-interventional medication. Seventy-six patients (50 %) were IMH(+), 82 (54 %) demonstrated HIC and 100 (66 %) MVO. IMH was detectable without HIC in 16 %, without MVO in 5 % and HIC without MVO in 6 %. Multivariable analyses revealed that IMH was associated with significant lower left ventricular ejection fraction and myocardial salvage index, larger left ventricular volume and infarct size. Patients with TIMI flow grade ≤1 before angioplasty demonstrated IMH significantly more often. CONCLUSIONS: IMH is associated with impaired left ventricular function and higher infarct size. T(2) and HIC imaging showed moderate agreement for IMH detection. T(2) (*) imaging might be the preferred CMR imaging method for comprehensive IMH assessment. KEY POINTS: • Intramyocardial haemorrhage is a common finding in patients with acute reperfused myocardial-infarction. • T (2) (*) imaging should be the preferred CMR method for assessment of intramyocardial haemorrhage. • Intramyocardial haemorrhage can be considered as an important influencing factor on patient’s outcome.
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spelling pubmed-42312832014-11-18 The relation between hypointense core, microvascular obstruction and intramyocardial haemorrhage in acute reperfused myocardial infarction assessed by cardiac magnetic resonance imaging Kandler, Diana Lücke, Christian Grothoff, Matthias Andres, Claudia Lehmkuhl, Lukas Nitzsche, Stefan Riese, Franziska Mende, Meinhard de Waha, Suzanne Desch, Steffen Lurz, Philipp Eitel, Ingo Gutberlet, Matthias Eur Radiol Cardiac BACKGROUND: Intramyocardial haemorrhage (IMH) and microvascular obstruction (MVO) represent reperfusion injury after reperfused ST-elevation myocardial infarction (STEMI) with prognostic impact and “hypointense core” (HIC) appearance in T(2)-weighted images. We aimed to distinguish between IMH and MVO by using T(2) (*)-weighted cardiovascular magnetic resonance imaging (CMR) and analysed influencing factors for IMH development. METHODS AND RESULTS: A total of 151 patients with acute STEMI underwent CMR after primary angioplasty. T(2)-STIR sequences were used to identify HIC, late gadolinium enhancement to visualise MVO and T(2) (*)-weighted sequences to detect IMH. IMH(+)/IMH(−) patients were compared considering infarct size, myocardial salvage, thrombolysis in myocardial infarction (TIMI) flow, reperfusion time, ventricular volumes, function and pre-interventional medication. Seventy-six patients (50 %) were IMH(+), 82 (54 %) demonstrated HIC and 100 (66 %) MVO. IMH was detectable without HIC in 16 %, without MVO in 5 % and HIC without MVO in 6 %. Multivariable analyses revealed that IMH was associated with significant lower left ventricular ejection fraction and myocardial salvage index, larger left ventricular volume and infarct size. Patients with TIMI flow grade ≤1 before angioplasty demonstrated IMH significantly more often. CONCLUSIONS: IMH is associated with impaired left ventricular function and higher infarct size. T(2) and HIC imaging showed moderate agreement for IMH detection. T(2) (*) imaging might be the preferred CMR imaging method for comprehensive IMH assessment. KEY POINTS: • Intramyocardial haemorrhage is a common finding in patients with acute reperfused myocardial-infarction. • T (2) (*) imaging should be the preferred CMR method for assessment of intramyocardial haemorrhage. • Intramyocardial haemorrhage can be considered as an important influencing factor on patient’s outcome. Springer Berlin Heidelberg 2014-08-06 2014 /pmc/articles/PMC4231283/ /pubmed/25097126 http://dx.doi.org/10.1007/s00330-014-3318-3 Text en © The Author(s) 2014 https://creativecommons.org/licenses/by-nc/4.0/ Open Access This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.
spellingShingle Cardiac
Kandler, Diana
Lücke, Christian
Grothoff, Matthias
Andres, Claudia
Lehmkuhl, Lukas
Nitzsche, Stefan
Riese, Franziska
Mende, Meinhard
de Waha, Suzanne
Desch, Steffen
Lurz, Philipp
Eitel, Ingo
Gutberlet, Matthias
The relation between hypointense core, microvascular obstruction and intramyocardial haemorrhage in acute reperfused myocardial infarction assessed by cardiac magnetic resonance imaging
title The relation between hypointense core, microvascular obstruction and intramyocardial haemorrhage in acute reperfused myocardial infarction assessed by cardiac magnetic resonance imaging
title_full The relation between hypointense core, microvascular obstruction and intramyocardial haemorrhage in acute reperfused myocardial infarction assessed by cardiac magnetic resonance imaging
title_fullStr The relation between hypointense core, microvascular obstruction and intramyocardial haemorrhage in acute reperfused myocardial infarction assessed by cardiac magnetic resonance imaging
title_full_unstemmed The relation between hypointense core, microvascular obstruction and intramyocardial haemorrhage in acute reperfused myocardial infarction assessed by cardiac magnetic resonance imaging
title_short The relation between hypointense core, microvascular obstruction and intramyocardial haemorrhage in acute reperfused myocardial infarction assessed by cardiac magnetic resonance imaging
title_sort relation between hypointense core, microvascular obstruction and intramyocardial haemorrhage in acute reperfused myocardial infarction assessed by cardiac magnetic resonance imaging
topic Cardiac
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4231283/
https://www.ncbi.nlm.nih.gov/pubmed/25097126
http://dx.doi.org/10.1007/s00330-014-3318-3
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