Affiliation:
1. BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
2. Robertson Center for Biostatistics, University of Glasgow, UK
3. West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Glasgow, UK
Abstract
Background
The time course and relationships of myocardial hemorrhage and edema in patients after acute
ST
‐segment elevation myocardial infarction (
STEMI
) are uncertain.
Methods and Results
Patients with
ST
‐segment elevation myocardial infarction treated by primary percutaneous coronary intervention underwent cardiac magnetic resonance imaging on 4 occasions: at 4 to 12 hours, 3 days, 10 days, and 7 months after reperfusion. Myocardial edema (native T2) and hemorrhage (T2*) were measured in regions of interest in remote and injured myocardium. Myocardial hemorrhage was taken to represent a hypointense infarct core with a T2* value <20 ms. Thirty patients with
ST
‐segment elevation myocardial infarction (mean age 54 years; 25 [83%] male) gave informed consent. Myocardial hemorrhage occurred in 7 (23%), 13 (43%), 11 (33%), and 4 (13%) patients at 4 to 12 hours, 3 days, 10 days, and 7 months, respectively, consistent with a unimodal pattern. The corresponding median amounts of myocardial hemorrhage (percentage of left ventricular mass) during the first 10 days after myocardial infarction were 2.7% (interquartile range [
IQR
] 0.0–5.6%), 7.0% (
IQR
4.9–7.5%), and 4.1% (
IQR
2.6–5.5%;
P
<0.001). Similar unimodal temporal patterns were observed for myocardial edema (percentage of left ventricular mass) in all patients (
P
=0.001) and for infarct zone edema (T2, in ms: 62.1 [
SD
2.9], 64.4 [
SD
4.9], 65.9 [
SD
5.3];
P
<0.001) in patients without myocardial hemorrhage. Alternatively, in patients with myocardial hemorrhage, infarct zone edema was reduced at day 3 (T2, in ms: 51.8 [
SD
4.6];
P
<0.001), depicting a bimodal pattern. Left ventricular end‐diastolic volume increased from baseline to 7 months in patients with myocardial hemorrhage (
P
=0.001) but not in patients without hemorrhage (
P
=0.377).
Conclusions
The temporal evolutions of myocardial hemorrhage and edema are unimodal, whereas infarct zone edema (T2 value) has a bimodal pattern. Myocardial hemorrhage is prognostically important and represents a target for therapeutic interventions that are designed to preserve vascular integrity following coronary reperfusion.
Clinical Trial Registration
URL
:
https://clinicaltrials.gov/
. Unique identifier:
NCT
02072850.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
108 articles.
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