No Reflow as a negative prognostic factor: its incidence and its role evalued through Cardiac Magnetic Resonance and Coronary Angiography

Congress:

ESCR 2014

Poster Number:

448

Type:

Scientific Poster

Keywords:

Cardiac, MR, MR-Angiography, Angioplasty, CAD, Outcomes analysis, Ischaemia / Infarction, Outcomes

Authors:

G. Benedetti, A. Damascelli, M. Cava, U. Gianni, A. Durante, A. Colombo, A. Margonato, A. Esposito, P. G. Camici, A. Del Maschio, F. De Cobelli; Milan/IT

DOI:

DOI-Link:

https://dx.doi.org/

Fig. 1: CMR, two chambers long axis LE sequence

Fig. 2: CMR, two chambers short axis LE sequence

Fig. 3: MVO phatophisiology

Fig. 4: CMR post processing of a two chamber short axis LE sequence, MVO % calculation

Purpose

No reflow (NR) is a phenomenon due to several factors, mainly to microvascular obstruction (MVO). MVO has partially known implication in STEMI patient’s outcome. The best tools to assess the presence of NR are CMR and angiography. The aim of our study is to assess CMR superiority, compared to angiography, to detect MVO and assess and predict patient’s outcome.

Methods and Materials

We enrolled in our study all consecutive STEMI patients admitted to our ER, who underwent percutaneous coronary intervention (PCI) within 12 hours from simptoms onset and CMR within 5 days from the acute event. Angiographic criteriafor NR were TIMI flow grade <3 and Myocardial Blush Grade <2; CMR criteria for NR were the presence of subendocardial lack of enhancement on first-pass perfusion (FPP) and of hypointense region within the infarcted area on late enhancement (LE). All MRI images were re-elaborated on a semi-automatic software. We...

Results

58 patients (age 60 ± 10 yrs) were enrolled in the study, 42 of whom have been followed up for 6 months. Tirthyseven patients had evidence of MVO (5.24 ± 4.38 %) at CMR, while angiography detected only 21 (p= 0.002). CMR - CMR + Angiography - 19 (32%) 18 (31%) 37 (63%) Angiography + 2 (3%) 19 (32%) 21 (35%) 21 (35%) 37 (63%) 58 Angiography and CMR in MVO detection Pts with MVO had worse acute functional parameters: lover LV EF% (46.52 vs...

Conclusion

These data confirm that CMR is more powerful than angiography in MVO identification. MVO at CMR may help to identify pts with worse acute situation, and at higher incidence of adverse events and TLR need.

References

Figure 3: Kloner R. No-Reflow Phenomenon: Maintaining Vascular Integrity. Journal of Cardiovascular Pharmacology and Therapeutics 2011