Myocardial hemorrhage after acute reperfused ST-segment-elevation myocardial infarction

Carrick, D. et al. (2016) Myocardial hemorrhage after acute reperfused ST-segment-elevation myocardial infarction. Circulation: Cardiovascular Imaging, 9(1), e004148. (doi: 10.1161/CIRCIMAGING.115.004148) (PMID:26763281) (PMCID:PMC4718183)

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Background—The success of coronary reperfusion therapy in ST-segment–elevation myocardial infarction (MI) is commonly limited by failure to restore microvascular perfusion. Methods and Results—We performed a prospective cohort study in patients with reperfused ST-segment–elevation MI who underwent cardiac magnetic resonance 2 days (n=286) and 6 months (n=228) post MI. A serial imaging time-course study was also performed (n=30 participants; 4 cardiac magnetic resonance scans): 4 to 12 hours, 2 days, 10 days, and 7 months post reperfusion. Myocardial hemorrhage was taken to represent a hypointense infarct core with a T2* value of <20 ms. Microvascular obstruction was assessed with late gadolinium enhancement. Adverse remodeling was defined as an increase in left ventricular end-diastolic volume ≥20% at 6 months. Cardiovascular death or heart failure events post discharge were assessed during follow-up. Two hundred forty-five patients had evaluable T2* data (mean±age, 58 [11] years; 76% men). Myocardial hemorrhage 2 days post MI was associated with clinical characteristics indicative of MI severity and inflammation. Myocardial hemorrhage was a multivariable associate of adverse remodeling (odds ratio [95% confidence interval]: 2.64 [1.07–6.49]; P=0.035). Ten (4%) patients had a cardiovascular cause of death or experienced a heart failure event post discharge, and myocardial hemorrhage, but not microvascular obstruction, was associated with this composite adverse outcome (hazard ratio, 5.89; 95% confidence interval, 1.25–27.74; P=0.025), including after adjustment for baseline left ventricular end-diastolic volume. In the serial imaging time-course study, myocardial hemorrhage occurred in 7 (23%), 13 (43%), 11 (33%), and 4 (13%) patients 4 to 12 hours, 2 days, 10 days, and 7 months post reperfusion. The amount of hemorrhage (median [interquartile range], 7.0 [4.9–7.5]; % left ventricular mass) peaked on day 2 (P<0.001), whereas microvascular obstruction decreased with time post reperfusion. Conclusions—Myocardial hemorrhage and microvascular obstruction follow distinct time courses post ST-segment–elevation MI. Myocardial hemorrhage was more closely associated with adverse outcomes than microvascular obstruction.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Berry, Professor Colin and Welsh, Professor Paul and Carrick, Dr David and Petrie, Professor Mark and Rauhalammi, Mr Samuli and Eteiba, Professor Hany and Oldroyd, Dr Keith and Haig, Dr Caroline and Sattar, Professor Naveed and Ford, Professor Ian and Mordi, Dr Ify and Radjenovic, Dr Aleksandra and Hood, Dr Stuart and Ahmed, Mr Nadeem
Authors: Carrick, D., Haig, C., Watkins, S., Ahmed, N., McEntegart, M., Petrie, M. C., Eteiba, H., Hood, S., Watkins, S., Lindsay, M. M., Davie, A., Mahrous, A., Mordi, I., Rauhalammi, S., Sattar, N., Welsh, P., Radjenovic, A., Ford, I., Oldroyd, K., and Berry, C.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
Journal Name:Circulation: Cardiovascular Imaging
Publisher:Lippincott Williams & Wilkins
ISSN (Online):1942-0080
Copyright Holders:Copyright © 2016 The Authors
First Published:First published in Circulation: Cardiovascular Imaging 9(1):e004148
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
612031Cardiac biomarkers and CVD risk screening: a cost-effective public health measure?Paul WelshBritish Heart Foundation (BHF)FS/12/62/29889RI CARDIOVASCULAR & MEDICAL SCIENCES