Temporal evolution of myocardial hemorrhage and edema in patients after acute ST-elevation myocardial infarction: pathophysiologic insights and clinical implications

Carrick, D. et al. (2016) Temporal evolution of myocardial hemorrhage and edema in patients after acute ST-elevation myocardial infarction: pathophysiologic insights and clinical implications. Journal of the American Heart Association, 5, e002834. (doi:10.1161/JAHA.115.002834) (PMID:26908408) (PMCID:PMC4802451)

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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.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Carrick, Dr David and Rauhalammi, Mr Samuli and Clerfond, Dr Guillaume and Hood, Dr Stuart and Welsh, Dr Paul and Eteiba, Dr H and Petrie, Professor Mark and Oldroyd, Dr Keith and Ford, Professor Ian and Berry, Professor Colin and Haig, Dr Caroline and Sattar, Professor Naveed and Mordi, Dr Ify and Radjenovic, Dr Aleksandra
Authors: Carrick, D., Haig, C., Rauhalammi, S., Clerfond, G., Ahmed, N., Mordi, I., McEntegart, M., Petrie, M., Eteiba, H., Hood, S., Watkins, S., Lindsay, M. M., Mahrous, A., Welsh, P., Sattar, N., Ford, I., Oldroyd, K., Radjenovic, A., and Berry, C.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:Journal of the American Heart Association
Publisher:Wiley
ISSN:2047-9980
ISSN (Online):2047-9980
Copyright Holders:Copyright © 2016 The Authors
First Published:First published in Journal of the American Heart Association 5:e002834
Publisher Policy:Reproduced under a Creative Commons License
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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
544551Validation and significance of myocardial haemorrhage revealed by "bright blood" T2-weighted MRI in heart attack survivors: a prospective cohort study.Colin BerryBritish Heart Foundation (BHF)PG/11/2/28474RI CARDIOVASCULAR & MEDICAL SCIENCES