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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.

Kandler D, L√ľcke C, Grothoff M, Andres C, Lehmkuhl L, Nitzsche S, Riese F, Mende M, de Waha S, Desch S, Lurz P, Eitel I, Gutberlet M - Eur Radiol (2014)

Bottom Line: 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.Intramyocardial haemorrhage can be considered as an important influencing factor on patient's outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic and Interventional Radiology, University Leipzig - Heart Centre, Str√ľmpellstra√üe 39, 04289, Leipzig, Germany.

ABSTRACT

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 T2-weighted images. We aimed to distinguish between IMH and MVO by using T2 (*)-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. T2-STIR sequences were used to identify HIC, late gadolinium enhancement to visualise MVO and T2 (*)-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 ‚ȧ1 before angioplasty demonstrated IMH significantly more often.

Conclusions: IMH is associated with impaired left ventricular function and higher infarct size. T2 and HIC imaging showed moderate agreement for IMH detection. T2 (*) 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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IMH with MVO and HIC: Short-axis CMR images obtained 2¬†days after ischemic reperfusion injury (pain-to-balloon time 523¬†min) in a 53-year-old man. In the anteroseptal myocardium a large transmural hyperintense region and HIC directly centrally located therein (white arrows) are present on the T2-STIR image (a); also, a major hyperintense, contrast-enhancing region (necrosis) with a clear MVO (white arrows)¬†within can be visualised on the LGE image (b) and a huge haemorrhage indicated by a hypointense signal (white arrows) can be seen on the T2*-weighted image at a TE of 15¬†ms (c) and within the T2*-weighted parameter image indicating a T2*-decay ‚ȧ20¬†ms (d), the threshold for haemorrhage in this study [16]
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Fig1: IMH with MVO and HIC: Short-axis CMR images obtained 2¬†days after ischemic reperfusion injury (pain-to-balloon time 523¬†min) in a 53-year-old man. In the anteroseptal myocardium a large transmural hyperintense region and HIC directly centrally located therein (white arrows) are present on the T2-STIR image (a); also, a major hyperintense, contrast-enhancing region (necrosis) with a clear MVO (white arrows)¬†within can be visualised on the LGE image (b) and a huge haemorrhage indicated by a hypointense signal (white arrows) can be seen on the T2*-weighted image at a TE of 15¬†ms (c) and within the T2*-weighted parameter image indicating a T2*-decay ‚ȧ20¬†ms (d), the threshold for haemorrhage in this study [16]

Mentions: Second, a stack of short-axis slices covering the whole LV using a black blood T2-weighted short tau inversion recovery (T2-STIR) sequence (TR‚ÄČ=‚ÄČ2¬†RR intervals, TE‚ÄČ=‚ÄČ80¬†ms, flip angle‚ÄČ=‚ÄČ90¬į, slice thickness‚ÄČ=‚ÄČ10¬†mm, maximum field of view (FOV)‚ÄČ=‚ÄČ370¬†mm, matrix 512‚ÄČ√ó‚ÄČ512, in-plane resolution <0.72‚ÄČ√ó‚ÄČ0.72‚ÄČ√ó‚ÄČ10¬†mm) were acquired for detecting HIC within myocardial oedema (Figs.¬†1a, 2a) and the area at risk (AAR) by a free-breathing navigator technique.Fig. 1


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

Kandler D, L√ľcke C, Grothoff M, Andres C, Lehmkuhl L, Nitzsche S, Riese F, Mende M, de Waha S, Desch S, Lurz P, Eitel I, Gutberlet M - Eur Radiol (2014)

IMH with MVO and HIC: Short-axis CMR images obtained 2¬†days after ischemic reperfusion injury (pain-to-balloon time 523¬†min) in a 53-year-old man. In the anteroseptal myocardium a large transmural hyperintense region and HIC directly centrally located therein (white arrows) are present on the T2-STIR image (a); also, a major hyperintense, contrast-enhancing region (necrosis) with a clear MVO (white arrows)¬†within can be visualised on the LGE image (b) and a huge haemorrhage indicated by a hypointense signal (white arrows) can be seen on the T2*-weighted image at a TE of 15¬†ms (c) and within the T2*-weighted parameter image indicating a T2*-decay ‚ȧ20¬†ms (d), the threshold for haemorrhage in this study [16]
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4231283&req=5

Fig1: IMH with MVO and HIC: Short-axis CMR images obtained 2¬†days after ischemic reperfusion injury (pain-to-balloon time 523¬†min) in a 53-year-old man. In the anteroseptal myocardium a large transmural hyperintense region and HIC directly centrally located therein (white arrows) are present on the T2-STIR image (a); also, a major hyperintense, contrast-enhancing region (necrosis) with a clear MVO (white arrows)¬†within can be visualised on the LGE image (b) and a huge haemorrhage indicated by a hypointense signal (white arrows) can be seen on the T2*-weighted image at a TE of 15¬†ms (c) and within the T2*-weighted parameter image indicating a T2*-decay ‚ȧ20¬†ms (d), the threshold for haemorrhage in this study [16]
Mentions: Second, a stack of short-axis slices covering the whole LV using a black blood T2-weighted short tau inversion recovery (T2-STIR) sequence (TR‚ÄČ=‚ÄČ2¬†RR intervals, TE‚ÄČ=‚ÄČ80¬†ms, flip angle‚ÄČ=‚ÄČ90¬į, slice thickness‚ÄČ=‚ÄČ10¬†mm, maximum field of view (FOV)‚ÄČ=‚ÄČ370¬†mm, matrix 512‚ÄČ√ó‚ÄČ512, in-plane resolution <0.72‚ÄČ√ó‚ÄČ0.72‚ÄČ√ó‚ÄČ10¬†mm) were acquired for detecting HIC within myocardial oedema (Figs.¬†1a, 2a) and the area at risk (AAR) by a free-breathing navigator technique.Fig. 1

Bottom Line: 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.Intramyocardial haemorrhage can be considered as an important influencing factor on patient's outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic and Interventional Radiology, University Leipzig - Heart Centre, Str√ľmpellstra√üe 39, 04289, Leipzig, Germany.

ABSTRACT

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 T2-weighted images. We aimed to distinguish between IMH and MVO by using T2 (*)-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. T2-STIR sequences were used to identify HIC, late gadolinium enhancement to visualise MVO and T2 (*)-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 ‚ȧ1 before angioplasty demonstrated IMH significantly more often.

Conclusions: IMH is associated with impaired left ventricular function and higher infarct size. T2 and HIC imaging showed moderate agreement for IMH detection. T2 (*) 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.

Show MeSH
Related in: MedlinePlus