Document Detail

Assessment of severe reperfusion injury with T2* cardiac MRI in patients with acute myocardial infarction.
MedLine Citation:
PMID:  20965977     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: In patients with acute myocardial infarction, restoration of coronary flow by primary coronary intervention (PCI) can lead to profound ischaemia-reperfusion injury with detrimental effects on myocardial salvage. Non-invasive assessment of interstitial myocardial haemorrhage by T2* cardiac MRI (T2*-CMR) provides a novel and specific biomarker of severe reperfusion injury which may be of prognostic value.
OBJECTIVE: To characterise the determinants of acute ischaemia-reperfusion injury following ST elevation myocardial infarction (STEMI) using CMR.
METHODS AND RESULTS: Fifty patients with acute STEMI who had been successfully treated by PCI were studied. T2*-CMR was used to identify the presence of reperfusion haemorrhage and contrast enhancement was used to measure microvascular obstruction (MVO) and infarct size. Haemorrhagic ischaemia-reperfusion injury was present in 29 patients (58%) following PCI and occurred despite rapid revascularisation (mean 4.2±3.3 h). Haemorrhage was only present when the infarct involved at least 80% (mean±SD 91±5.3%) of the left ventricular wall thickness. There was a strong association between the extent of MVO and reperfusion haemorrhage (r(2)=0.87, p<0.001). Transmural infarcts (n=43) showed significantly impaired systolic wall thickening at the infarct mid point when reperfusion haemorrhage was present (21.5±16.7% vs 3.7±12.9%), p<0.0001) compared with non-haemorrhagic infarcts.
CONCLUSIONS: Severe reperfusion injury may occur when there is near-transmural myocardial necrosis despite early and successful revascularisation. Reperfusion haemorrhage is closely associated with the development of MVO. These findings indicate that, once advanced necrosis has developed, the potential for severe myocardial reperfusion injury is significantly enhanced.
Declan P O'Regan; Ben Ariff; Clare Neuwirth; Yvonne Tan; Giuliana Durighel; Stuart A Cook
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-10-21
Journal Detail:
Title:  Heart (British Cardiac Society)     Volume:  96     ISSN:  1468-201X     ISO Abbreviation:  Heart     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-11-10     Completed Date:  2011-05-16     Revised Date:  2014-02-20    
Medline Journal Info:
Nlm Unique ID:  9602087     Medline TA:  Heart     Country:  England    
Other Details:
Languages:  eng     Pagination:  1885-91     Citation Subset:  AIM; IM    
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MeSH Terms
Aged, 80 and over
Angioplasty, Balloon, Coronary / adverse effects
Anticoagulants / therapeutic use
Hemorrhage / etiology
Magnetic Resonance Angiography
Microcirculation / physiology
Middle Aged
Myocardial Infarction / therapy*
Myocardial Reperfusion / adverse effects
Myocardial Reperfusion Injury / pathology*
Young Adult
Grant Support
MC_U120085815//Medical Research Council; //Medical Research Council
Reg. No./Substance:

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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