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Open Access 01-12-2014 | Cardiac

The relation between hypointense core, microvascular obstruction and intramyocardial haemorrhage in acute reperfused myocardial infarction assessed by cardiac magnetic resonance imaging

Authors: Diana Kandler, Christian Lücke, Matthias Grothoff, Claudia Andres, Lukas Lehmkuhl, Stefan Nitzsche, Franziska Riese, Meinhard Mende, Suzanne de Waha, Steffen Desch, Philipp Lurz, Ingo Eitel, Matthias Gutberlet

Published in: European Radiology | Issue 12/2014

Abstract

Background

Intramyocardial haemorrhage (IMH) and microvascular obstruction (MVO) represent reperfusion injury after reperfused ST-elevation myocardial infarction (STEMI) with prognostic impact and “hypointense core” (HIC) appearance in T₂-weighted images. We aimed to distinguish between IMH and MVO by using T₂ ^*-weighted cardiovascular magnetic resonance imaging (CMR) and analysed influencing factors for IMH development.

Methods and results

A total of 151 patients with acute STEMI underwent CMR after primary angioplasty. T₂-STIR sequences were used to identify HIC, late gadolinium enhancement to visualise MVO and T₂ ^*-weighted sequences to detect IMH. IMH⁺/IMH⁻ patients were compared considering infarct size, myocardial salvage, thrombolysis in myocardial infarction (TIMI) flow, reperfusion time, ventricular volumes, function and pre-interventional medication. Seventy-six patients (50 %) were IMH⁺, 82 (54 %) demonstrated HIC and 100 (66 %) MVO. IMH was detectable without HIC in 16 %, without MVO in 5 % and HIC without MVO in 6 %. Multivariable analyses revealed that IMH was associated with significant lower left ventricular ejection fraction and myocardial salvage index, larger left ventricular volume and infarct size. Patients with TIMI flow grade ≤1 before angioplasty demonstrated IMH significantly more often.

Conclusions

IMH is associated with impaired left ventricular function and higher infarct size. T₂ and HIC imaging showed moderate agreement for IMH detection. T₂ ^* imaging might be the preferred CMR imaging method for comprehensive IMH assessment.

Key Points

• Intramyocardial haemorrhage is a common finding in patients with acute reperfused myocardial-infarction.

• T ₂ ^* imaging should be the preferred CMR method for assessment of intramyocardial haemorrhage.

• Intramyocardial haemorrhage can be considered as an important influencing factor on patient’s outcome.

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Title: The relation between hypointense core, microvascular obstruction and intramyocardial haemorrhage in acute reperfused myocardial infarction assessed by cardiac magnetic resonance imaging
Authors: Diana Kandler
Christian Lücke
Matthias Grothoff
Claudia Andres
Lukas Lehmkuhl
Stefan Nitzsche
Franziska Riese
Meinhard Mende
Suzanne de Waha
Steffen Desch
Philipp Lurz
Ingo Eitel
Matthias Gutberlet
Publication date: 01-12-2014
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 12/2014
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-014-3318-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The relation between hypointense core, microvascular obstruction and intramyocardial haemorrhage in acute reperfused myocardial infarction assessed by cardiac magnetic resonance imaging

Abstract

Background

Methods and results

Conclusions

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods and results

Conclusions

Key Points

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