Vargas-Barrón J, González-Pacheco H, Meléndez-Ramírez G, Roldán FJ, Damas-De los Santos F, Meave-González A, Martínez-Sánchez C

Language: English
References: 17
Page: 107-112
PDF size: 249.76 Kb.

ABSTRACT

Objective. The presence of intramyocardial hemorrhage (IMH) is frequent in patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PPCI). We aim for the presence IMH using cMRI in patients who presented AMI and did not undergo PPCI or thrombolysis. Cardiac magnetic resonance has proven to be a highly sensitive method for detect its presence in the ischemic damaged tissue. Material and methods. Patients admitted with diagnosis of ST elevation myocardial infarction › 24 h after initial presentation and without reperfusion therapy were enrolled in the study. All patients underwent cardiac magnetic resonance for detecting edema, microvascular obstruction and intramyocardial hemorrhage, followed by coronary angiography. Results. Seven male patients, with median age of 53 years, were enrolled. Cardiac magnetic resonance showed that all patients had microvascular obstruction and edema. Two of them had intramyocardial hemorrhage in association with spontaneous reperfusion demonstrated by angiography. Conclusion. The results of our study show that in patients with acute myocardial infarction, intramyocardial hemorrhage occurs not only after therapeutic, but also after spontaneous reperfusion. This is the first time that its presence is demonstrated by cardiac magnetic resonance.

REFERENCES

1. Yellon DM, Hausenloy DJ. Myocardial reperfusion injury. N Engl J Med 2007; 357: 1121-35.

2. Perazzolo MM, Cacciavillani L, Corbetti F, et al. The contribution of intramyocardial haemorrhage to the “no-reflow phenomenon”: A study performed by cardiac magnetic resonance. Echocardiography 2010; 27: 1120-9.

3. FishbeinMC, Rit J, Lando U. The relationship of vascular injury and myocardial hemorrhage to necrosis after reperfusion. Circulation 1980; 62: 1274-9.

4. Basso C, Corbetti F, Silva C, et al. Morphologic validation of reperfused hemorrhagic myocardial infarction by cardiovascular magnetic resonance. Am J Cardiol 2007; 100: 1322-7.

5. Bekkers SC, Smulders MW, Lima PV, et al. Clinical implications of microvascular obstruction and intramyocardial haemorrhage in acute myocardial infarction using cardiovascular magnetic resonance imaging. Eur Radiol 2010; 20: 2572-8.

6. van de Bos EJ, Baks T, Moelker AD, Kerver W, van Geun RJ, van der Giessen WJ, Duncker DJ, et al. Magnetic resonance imaging of haemorrhage within reperfused myocardial infarcts: possible interference with iron oxide-labelled cell tracking? Eur Heart J 2006; 27: 1620-6.

7. Nijveldt R, Beek AM, Hofman MB, et al. Late gadolinium-enhanced cardiovascular magnetic resonance evaluation of infarct size and microvascular obstruction in optimally treated patients after acute myocardial infarction. J Cardiovasc Magn Reson 2007; 9: 765-70.

8. Beek AM, Nijveldt R, van Rossum AC. Intramyocardial hemorrhage and microvascular obstruction after primary percutaneous coronary intervention. Int J Cardiovasc Imaging 2010; 26: 49-55.

9. Gerber BL, Rochitte CE, Melin JA, et al. Microvascular obstruction and left ventricular remodeling early after acute myocardial infarction. Circulation 2000; 101: 2734-41.

10. Wood JC, Otto-Duessel M, Aguilar M, et al. Cardiac Iron Determines Cardiac T2*, T2, and T1 in the Gerbil Model of Iron Cardiomyopathy. Circulation 2005; 112: 535-43.

11. Asanuma T, Tanabe K, Ochiai K, et al. Relationship between progressive microvascular damage and intramyocardial hemorrhage in patients with reperfused anterior myocardial infarction. Circulation 1997; 96: 448-53.

12. Antman EM, Anbe DT, Armstrong PW, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2004; 44: e1-e211.

13. Kim RJ, Chen EL, Lima JA, et al. Myocardial GD-DTPA kinetics determine MRI contrast enhancement and reflect the extent and severity of myocardial injury after acute reperfused infarction. Circulation 1996; 94: 3318-26.

14. Bresnahan GF, Roberts R, Shell WE, et al. Deleterious effects due to hemorrhage after myocardial reperfusion. Am J Cardiol 1974; 33: 82-6.

15. Ochiai K, Shimada T, Murakami Y, et al. Hemorrhagic myocardial infarction after coronary reperfusion detected in vivo by magnetic resonance imaging in humans: prevalence and clinical implications. J Cardiovasc Magn Reson 1999; 1: 247-56.

16. Amabile N, Jacquier A, Shuhab A, et al. Incidence, predictors, and prognostic value of intramyocardial hemorrhage lesions in ST elevation myocardial infarction. Catheter Cardiovasc Interv 2012; 79: 1101-08.

17. Basso C, Rizzo S, Thiene G. The metamorphosis of myocardial infarction following coronary recanalization. Cardiovasc Pathol 2010; 19: 22-28.