Temporal Evolution of Myocardial Hemorrhage and Edema in Patients After Acute ST-Segment Elevation Myocardial Infarction: Pathophysiological Insights and Clinical Implications

被引：128

作者：

Carrick, David ^{[1
,3
]}

Haig, Caroline ^{[2
]}

Ahmed, Nadeem ^{[1
]}

Rauhalammi, Samuli ^{[1
]}

Clerfond, Guillaume ^{[1
]}

Carberry, Jaclyn ^{[1
]}

Mordi, Ify ^{[1
,2
]}

McEntegart, Margaret ^{[3
]}

Petrie, Mark C. ^{[1
,3
]}

Eteiba, Hany ^{[3
]}

Hood, Stuart ^{[3
]}

Watkins, Stuart ^{[3
]}

Lindsay, M. Mitchell ^{[3
]}

Mahrous, Ahmed ^{[3
]}

Welsh, Paul ^{[1
]}

Sattar, Naveed ^{[1
]}

Ford, Ian

Oldroyd, Keith G. ^{[1
,3
]}

Radjenovic, Aleksandra ^{[1
]}

Berry, Colin ^{[1
,3
]}

机构：

[1] Univ Glasgow, BHF Glasgow Cardiovasc Res Ctr, Inst Cardiovasc & Med Sci, 126 Univ Pl, Glasgow G12 8TA, Lanark, Scotland

[2] Univ Glasgow, Robertson Ctr Biostat, Glasgow G12 8TA, Lanark, Scotland

[3] Golden Jubilee Natl Hosp, West Scotland Heart & Lung Ctr, Glasgow, Lanark, Scotland

来源：

JOURNAL OF THE AMERICAN HEART ASSOCIATION | 2016年 / 5卷 / 02期

关键词：

magnetic resonance imaging; myocardial edema; myocardial hemorrhage; myocardial infarction; pathophysiology; reperfusion injury; CARDIOVASCULAR MAGNETIC-RESONANCE; NO-REFLOW PHENOMENON; MICROVASCULAR OBSTRUCTION; INTRAMYOCARDIAL HEMORRHAGE; PROGNOSTIC VALUE; ISCHEMIC AREA; DIAGNOSTIC-ACCURACY; INVERSION-RECOVERY; T2; QUANTIFICATION; T2-WEIGHTED MRI;

D O I：

10.1161/JAHA.115.002834

中图分类号：

R5 [内科学];

学科分类号：

100201 [内科学];

摘要：

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.

引用

页数：13

共 48 条

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