Temporal evolution of myocardial hemorrhage and edema in patients after acute st-segment elevation myocardial infarction: Pathophysiological insights and clinical implications

David Carrick, Caroline Haig, Nadeem Ahmed, Samuli Rauhalammi, Guillaume Clerfond, Jaclyn Carberry, Ify Mordi, Margaret McEntegart, Mark C. Petrie, Hany Eteiba, Stuart Hood, Stuart Watkins, Mitchell Lindsay, Ahmed Mahrous, Paul Welsh, Naveed Sattar, Ian Ford, Keith G. Oldroyd, Aleksandra Radjenovic, Colin Berry

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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.

    Original languageEnglish
    Article numbere002834
    JournalJournal of the American Heart Association
    Volume5
    Issue number2
    DOIs
    Publication statusPublished - 1 Jan 2016

    Keywords

    • Magnetic resonance imaging
    • Myocardial edema
    • Myocardial hemorrhage
    • Myocardial infarction
    • Pathophysiology
    • Reperfusion injury

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