Abstract
Infarct size (IS) and microvascular obstruction (MO) following ST-elevation myocardial infarction (STEMI) reperfusion may affect left ventricular (LV) remodeling. We evaluated the impact of extent and transmurality of IS and MO in LV remodeling using contrast-enhanced cardiac magnetic resonance imaging (MRI). Thirty-six consecutive patients presenting with a first STEMI and undergoing contrast-enhanced cardiac MRI within 5 days of successful primary percutaneous coronary intervention (PPCI) were enrolled. Gadolinium-enhanced MRI at first passage and in delayed imaging was performed to assess MO and IS. LV remodeling was evaluated by echocardiography at 6-month-follow-up and defined as a percent increase in the LV end-diastolic volume >20%. Thirteen patients (36%) developed LV remodeling. IS and MO extent score was associated with LV remodeling (OR 1.5, 95% CI 1.02–2.38, P = 0.04, and OR 3.1, 95% CI 1.45–6.64, P = 0.003, respectively), along with IS and MO trasmurality (OR 1.4, 95% CI 1.007–2.12, P = 0.046, and OR 3.1, 95% CI 1.24–7.89, P = 0.016, respectively). Importantly, IS and MO extent score combination gave an OR of 3.4 (95% CI 1.4–7.9, P = 0.004) and the combination of IS and MO transmurality increased the OR to 4.8 (95% CI 1.5–15.2, P = 0.007). Finally, when combining simultaneously IS and MO extent score and transmurality the OR reached 5.3 (95% CI 3.34–18.2, P = 0.0008). The evaluation of both IS and MO extent and transmurality by MRI is of prognostic utility in patients undergoing PPCI. Importantly, IS and MO transmurality significantly increases the risk of adverse remodeling and should be routinely assessed in post-STEMI patients.
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References
Pfeffer MA, Braunwald E (1990) Ventricular remodeling after myocardial infarction: experimental observations and clinical implications. Circulation 81:1161–1172
Baks T, van Geuns RJ, Biagini E et al (2006) Effects of primary angioplasty for acute myocardial infarction on early and late infarct size and left ventricular wall characteristics. J Am Coll Cardiol 47:40–44
Bolognese L, Carrabba N, Parodi G et al (2004) Impact of microvascular dysfunction on left ventricular remodeling and long-term clinical outcome after primary coronary angioplasty for acute myocardial infarction. Circulation 109:1121–1126
Galiuto L, Gabrielli FA, Lombardo A et al (2007) Reversible microvascular dysfunction coupled with persistent myocardial dysfunction: implications for post-infarct left ventricular remodeling. Heart 93:565–571
Lund GK, Stork A, Saeed M et al (2004) Acute myocardial infarction: evaluation with first-pass enhancement and delayed enhancement MR imaging compared with 201Tl SPECT imaging. Radiology 232:49–57
Hombach V, Grebe O, Merkle N et al (2005) Sequelae of acute myocardial infarction regarding cardiac structure and function and their prognostic significance as assessed by magnetic resonance imaging. Eur Heart J 26:549–557
Kachenoura N, Redheuil A, Herment A, Mousseaux E, Frouin F (2008) Robust assessment of the transmural extent of myocardial infarction in late gadolinium-enhanced MRI studies using appropriate angular and circumferential subdivision of the myocardium. Eur Radiol 18:2140–2147
Gerber BL, Rochitte CE, Melin JA et al (2000) Microvascular obstruction and left ventricular remodeling early after acute myocardial infarction. Circulation 101:2734–2741
Wu KC, Zerhouni EA, Judd RM et al (1998) Prognostic significance of microvascular obstruction by magnetic resonance imaging in patients with acute myocardial infarction. Circulation 97:765–772
Mollema SA, Liem SS, Suffoletto MS et al (2007) Left ventricular dyssynchrony acutely after myocardial infarction predicts left ventricular remodeling. J Am Coll Cardiol 50:1532–1540
TIMI Study Group (1985) The thrombolysis in myocardial infarction (TIMI) trial. Phase I findings. TIMI Study Group. N Engl J Med 312:932–936
Schuijf JD, Kaandorp TA, Lamb HJ et al (2004) Quantification of myocardial infarct size and transmurality by contrast-enhanced magnetic resonance imaging in men. Am J Cardiol 94:284–288
Porto I, Burzotta F, Brancati M et al (2007) Relation of myocardial blush grade to microvascular perfusion and to myocardial infarct size after primary or rescue percutaneous coronary intervention. Am J Cardiol 99:1671–1673
Cerqueira MD, Weissman NJ, Dilsizian V et al (2002) Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 105:539–542
Taylor AJ, Al-Saadi N, Abdel-Aty H, Schulz-Menger J, Messroghli DR, Friedrich MG (2004) Detection of acutely impaired microvascular reperfusion after infarct angioplasty with magnetic resonance imaging. Circulation 109:2080–2085
Orn S, Manhenke C, Anand IS et al (2007) Effect of left ventricular scar size, location and transmurality on left ventricular remodeling with healed myocardial infarction. Am J Cardiol 99:1109–1114
Lund GK, Stork A, Muellerleile K et al (2007) Prediction of left ventricular remodeling and analysis of infarct resorption in patients with reperfused myocardial infarcts by using contrast-enhanced MR imaging. Radiology 245:95–102
Nijveldt R, Hofman MB, Hirsch A et al (2009) Assessment of microvascular obstruction and prediction of short-term remodeling after acute myocardial infarction: cardiac MR imaging study. Radiology 250:363–370
Tarantini G, Razzolini R, Cacciavillani L et al (2006) Influence of transmurality, infarct size, and severe microvascular obstruction on left ventricular remodeling and function after primary coronary angioplasty. Am J Cardiol 98:1033–1040
Niccoli G, Burzotta F, Galiuto L, Crea F (2009) Myocardial no-reflow in humans. J Am Coll Cardiol 54:281–292
Masci PG, Ganame J, Francone M, et al (2011) Relationship between location and size of myocardial infarction and their reciprocal influences on post-infarction left ventricular remodelling. Eur Heart J. doi:10.1093/eurheartj/ehr064
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Lombardo, A., Niccoli, G., Natale, L. et al. Impact of microvascular obstruction and infarct size on left ventricular remodeling in reperfused myocardial infarction: a contrast-enhanced cardiac magnetic resonance imaging study. Int J Cardiovasc Imaging 28, 835–842 (2012). https://doi.org/10.1007/s10554-011-9901-7
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DOI: https://doi.org/10.1007/s10554-011-9901-7