Myocardial Hemorrhage After Acute Reperfused ST-Segment-Elevation Myocardial Infarction: Relation to Microvascular Obstruction and Prognostic Significance
The success of coronary reperfusion therapy in ST-segment-elevation myocardial infarction (MI) is commonly limited by failure to restore microvascular perfusion. We performed a prospective cohort study in patients with reperfused ST-segment-elevation MI who underwent cardiac magnetic resonance 2 day...
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| Veröffentlicht in: | Circulation. Cardiovascular imaging 2016-01, Vol.9 (1), p.e004148-e004148 |
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| creator | Carrick, David Haig, Caroline Ahmed, Nadeem McEntegart, Margaret Petrie, Mark C Eteiba, Hany Hood, Stuart Watkins, Stuart Lindsay, M Mitchell Davie, Andrew Mahrous, Ahmed Mordi, Ify Rauhalammi, Samuli Sattar, Naveed Welsh, Paul Radjenovic, Aleksandra Ford, Ian Oldroyd, Keith G Berry, Colin |
| description | The success of coronary reperfusion therapy in ST-segment-elevation myocardial infarction (MI) is commonly limited by failure to restore microvascular perfusion.
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 |
| doi_str_mv | 10.1161/CIRCIMAGING.115.004148 |
| format | Article |
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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.
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.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT02072850.</description><identifier>ISSN: 1941-9651</identifier><identifier>EISSN: 1942-0080</identifier><identifier>DOI: 10.1161/CIRCIMAGING.115.004148</identifier><identifier>PMID: 26763281</identifier><language>eng</language><publisher>United States: Lippincott Williams & Wilkins</publisher><subject>Biomarkers - blood ; Contrast Media ; Coronary Angiography ; Electrocardiography ; Female ; Hemorrhage - etiology ; Hemorrhage - mortality ; Hemorrhage - physiopathology ; Humans ; Magnetic Resonance Angiography ; Male ; Microcirculation ; Middle Aged ; Myocardial Infarction - complications ; Myocardial Infarction - mortality ; Myocardial Infarction - physiopathology ; Myocardial Infarction - therapy ; Myocardial Reperfusion ; Original ; Prognosis ; Prospective Studies</subject><ispartof>Circulation. Cardiovascular imaging, 2016-01, Vol.9 (1), p.e004148-e004148</ispartof><rights>2016 The Authors.</rights><rights>2016 The Authors. 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c313t-a80240ed48e07cfa650f420884c10bc90d9aeb84f7b896bcd950579e07ff97233</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,3674,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26763281$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Carrick, David</creatorcontrib><creatorcontrib>Haig, Caroline</creatorcontrib><creatorcontrib>Ahmed, Nadeem</creatorcontrib><creatorcontrib>McEntegart, Margaret</creatorcontrib><creatorcontrib>Petrie, Mark C</creatorcontrib><creatorcontrib>Eteiba, Hany</creatorcontrib><creatorcontrib>Hood, Stuart</creatorcontrib><creatorcontrib>Watkins, Stuart</creatorcontrib><creatorcontrib>Lindsay, M Mitchell</creatorcontrib><creatorcontrib>Davie, Andrew</creatorcontrib><creatorcontrib>Mahrous, Ahmed</creatorcontrib><creatorcontrib>Mordi, Ify</creatorcontrib><creatorcontrib>Rauhalammi, Samuli</creatorcontrib><creatorcontrib>Sattar, Naveed</creatorcontrib><creatorcontrib>Welsh, Paul</creatorcontrib><creatorcontrib>Radjenovic, Aleksandra</creatorcontrib><creatorcontrib>Ford, Ian</creatorcontrib><creatorcontrib>Oldroyd, Keith G</creatorcontrib><creatorcontrib>Berry, Colin</creatorcontrib><title>Myocardial Hemorrhage After Acute Reperfused ST-Segment-Elevation Myocardial Infarction: Relation to Microvascular Obstruction and Prognostic Significance</title><title>Circulation. Cardiovascular imaging</title><addtitle>Circ Cardiovasc Imaging</addtitle><description>The success of coronary reperfusion therapy in ST-segment-elevation myocardial infarction (MI) is commonly limited by failure to restore microvascular perfusion.
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.
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.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT02072850.</description><subject>Biomarkers - blood</subject><subject>Contrast Media</subject><subject>Coronary Angiography</subject><subject>Electrocardiography</subject><subject>Female</subject><subject>Hemorrhage - etiology</subject><subject>Hemorrhage - mortality</subject><subject>Hemorrhage - physiopathology</subject><subject>Humans</subject><subject>Magnetic Resonance Angiography</subject><subject>Male</subject><subject>Microcirculation</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - complications</subject><subject>Myocardial Infarction - mortality</subject><subject>Myocardial Infarction - physiopathology</subject><subject>Myocardial Infarction - therapy</subject><subject>Myocardial Reperfusion</subject><subject>Original</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><issn>1941-9651</issn><issn>1942-0080</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVUd1u0zAUthCIjcIrTL7kJuM4cRKHC6Sq2rpIK0PruLYc5zgzSuJiO5X2Kjwt6TqmcmXr-zvH_gi5YHDJWMG-rOr7Vb1Zruvv6xnILwE44-INOWcVTxMAAW-f7yypipydkQ8h_AIoMsjFe3KWFmWRpYKdkz-bJ6eVb63q6Q0OzvtH1SFdmoieLvUUkd7jDr2ZArZ0-5BssRtwjMlVj3sVrRvpSUI9GuX1Af062_ojHx3dWO3dXgU99crTuyZEPz3LqBpb-sO7bnQhWk23thutsVqNGj-Sd0b1AT-9nAvy8_rqYXWT3N6t69XyNtEZy2KiBKQcsOUCodRGFTkYnoIQXDNodAVtpbAR3JSNqIpGt1UOeVnNYmOqMs2yBfl2zN1NzYCtnl_nVS933g7KP0mnrPyfGe2j7Nxe8pIJJg4Bn18CvPs9YYhysEFj36sR3RQkKwsQJa9m7YIUR-n8HyF4NK9jGMhDsfKk2BnI5bHY2XhxuuSr7V-T2V_ZkKSm</recordid><startdate>201601</startdate><enddate>201601</enddate><creator>Carrick, David</creator><creator>Haig, Caroline</creator><creator>Ahmed, Nadeem</creator><creator>McEntegart, Margaret</creator><creator>Petrie, Mark C</creator><creator>Eteiba, Hany</creator><creator>Hood, Stuart</creator><creator>Watkins, Stuart</creator><creator>Lindsay, M Mitchell</creator><creator>Davie, Andrew</creator><creator>Mahrous, Ahmed</creator><creator>Mordi, Ify</creator><creator>Rauhalammi, Samuli</creator><creator>Sattar, Naveed</creator><creator>Welsh, Paul</creator><creator>Radjenovic, Aleksandra</creator><creator>Ford, Ian</creator><creator>Oldroyd, Keith G</creator><creator>Berry, Colin</creator><general>Lippincott Williams & Wilkins</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>201601</creationdate><title>Myocardial Hemorrhage After Acute Reperfused ST-Segment-Elevation Myocardial Infarction: Relation to Microvascular Obstruction and Prognostic Significance</title><author>Carrick, David ; Haig, Caroline ; Ahmed, Nadeem ; McEntegart, Margaret ; Petrie, Mark C ; Eteiba, Hany ; Hood, Stuart ; Watkins, Stuart ; Lindsay, M Mitchell ; Davie, Andrew ; Mahrous, Ahmed ; Mordi, Ify ; Rauhalammi, Samuli ; Sattar, Naveed ; Welsh, Paul ; Radjenovic, Aleksandra ; Ford, Ian ; Oldroyd, Keith G ; Berry, Colin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c313t-a80240ed48e07cfa650f420884c10bc90d9aeb84f7b896bcd950579e07ff97233</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Biomarkers - blood</topic><topic>Contrast Media</topic><topic>Coronary Angiography</topic><topic>Electrocardiography</topic><topic>Female</topic><topic>Hemorrhage - etiology</topic><topic>Hemorrhage - mortality</topic><topic>Hemorrhage - physiopathology</topic><topic>Humans</topic><topic>Magnetic Resonance Angiography</topic><topic>Male</topic><topic>Microcirculation</topic><topic>Middle Aged</topic><topic>Myocardial Infarction - complications</topic><topic>Myocardial Infarction - mortality</topic><topic>Myocardial Infarction - physiopathology</topic><topic>Myocardial Infarction - therapy</topic><topic>Myocardial Reperfusion</topic><topic>Original</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Carrick, David</creatorcontrib><creatorcontrib>Haig, Caroline</creatorcontrib><creatorcontrib>Ahmed, Nadeem</creatorcontrib><creatorcontrib>McEntegart, Margaret</creatorcontrib><creatorcontrib>Petrie, Mark C</creatorcontrib><creatorcontrib>Eteiba, Hany</creatorcontrib><creatorcontrib>Hood, Stuart</creatorcontrib><creatorcontrib>Watkins, Stuart</creatorcontrib><creatorcontrib>Lindsay, M Mitchell</creatorcontrib><creatorcontrib>Davie, Andrew</creatorcontrib><creatorcontrib>Mahrous, Ahmed</creatorcontrib><creatorcontrib>Mordi, Ify</creatorcontrib><creatorcontrib>Rauhalammi, Samuli</creatorcontrib><creatorcontrib>Sattar, Naveed</creatorcontrib><creatorcontrib>Welsh, Paul</creatorcontrib><creatorcontrib>Radjenovic, Aleksandra</creatorcontrib><creatorcontrib>Ford, Ian</creatorcontrib><creatorcontrib>Oldroyd, Keith G</creatorcontrib><creatorcontrib>Berry, Colin</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Circulation. Cardiovascular imaging</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Carrick, David</au><au>Haig, Caroline</au><au>Ahmed, Nadeem</au><au>McEntegart, Margaret</au><au>Petrie, Mark C</au><au>Eteiba, Hany</au><au>Hood, Stuart</au><au>Watkins, Stuart</au><au>Lindsay, M Mitchell</au><au>Davie, Andrew</au><au>Mahrous, Ahmed</au><au>Mordi, Ify</au><au>Rauhalammi, Samuli</au><au>Sattar, Naveed</au><au>Welsh, Paul</au><au>Radjenovic, Aleksandra</au><au>Ford, Ian</au><au>Oldroyd, Keith G</au><au>Berry, Colin</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Myocardial Hemorrhage After Acute Reperfused ST-Segment-Elevation Myocardial Infarction: Relation to Microvascular Obstruction and Prognostic Significance</atitle><jtitle>Circulation. Cardiovascular imaging</jtitle><addtitle>Circ Cardiovasc Imaging</addtitle><date>2016-01</date><risdate>2016</risdate><volume>9</volume><issue>1</issue><spage>e004148</spage><epage>e004148</epage><pages>e004148-e004148</pages><issn>1941-9651</issn><eissn>1942-0080</eissn><abstract>The success of coronary reperfusion therapy in ST-segment-elevation myocardial infarction (MI) is commonly limited by failure to restore microvascular perfusion.
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.
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.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT02072850.</abstract><cop>United States</cop><pub>Lippincott Williams & Wilkins</pub><pmid>26763281</pmid><doi>10.1161/CIRCIMAGING.115.004148</doi><oa>free_for_read</oa></addata></record> |
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| ispartof | Circulation. Cardiovascular imaging, 2016-01, Vol.9 (1), p.e004148-e004148 |
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| language | eng |
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| source | MEDLINE; American Heart Association Journals; EZB-FREE-00999 freely available EZB journals |
| subjects | Biomarkers - blood Contrast Media Coronary Angiography Electrocardiography Female Hemorrhage - etiology Hemorrhage - mortality Hemorrhage - physiopathology Humans Magnetic Resonance Angiography Male Microcirculation Middle Aged Myocardial Infarction - complications Myocardial Infarction - mortality Myocardial Infarction - physiopathology Myocardial Infarction - therapy Myocardial Reperfusion Original Prognosis Prospective Studies |
| title | Myocardial Hemorrhage After Acute Reperfused ST-Segment-Elevation Myocardial Infarction: Relation to Microvascular Obstruction and Prognostic Significance |
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