Purpose
Microvascular obstruction (MVO) may occur in patients with ST-elevated myocardial infarction (STEMI),
after percutaneous coronary revascularization,
and has recently been associated with a worse prognosis,
but the cause is still unknown.
One possible explanation would be that MVO leads to left ventricular dilation and remodeling,
so the aim of our study is to analyse whether MVO has an effect of left ventricular function.
Cardiac Magnetic Resonance (CMR) has been identified as the gold standard technique for MVO evaluation.
The aim of this study is to...
Methods and Materials
In this ongoing prospective study we enrolled 58 consecutive STEMI patients,
admitted to our ER and treated with PCI,
within 12 hours of symptom onset.
Patients underwent a first CMR study within 5 days from the infarction.
A subgroup underwent a second CMR as well,
after 6 months.
Both CMR were performed on a 1.5 T magnet,
with the assessment of cine sequences for volumes and function,
STIR sequences for oedema,
volumetric first pass perfusion (FPP) for MVO identification and late gadolinium enhancement (LGE) sequences...
Results
Up to now 16 patients (age 59±8 yrs; 15 male and 1 female) were studied with two CMRs (Fig.
3).
Patients with MVO showed a significant increase in EDV and ESV compared to patients without MVO (∆EDV=34±32ml,
p=0.004 vs ∆EDV=4.5±16ml,
p=0.6 and ∆ESV=15±19 ml,
p=0.018 vs ∆ESV=1±15ml,
p=0.9) (Fig.
4).At regression analysis MVO,
LGE and perfusion defect significantly correlated with ∆EDV (MVO%: p<0.001; LGE%: p=0.006; perfusion defect%: p=0.001) and ∆ESV (MVO%: p<0.001; LE%: p=0.03; perfusion defect%: p=0.005).At multivariate analysis only MVO% presented a significant relation...
Conclusion
These preliminary data suggest that MVO extent is correlated with left ventricle remodeling after myocardial infarction with a stronger effect on left ventricle enlargement than LE.
References
Ndrepepa G.
5-Year Value of No-Reflow Phenomenon After Percuteneus Coronary Intervention in Patients With Myocardail Infarction. JACC 2010
Husser O.
Cardiovascular Magnetic resonace-derived intramyocardial hemorrhage after STEMI: Influence on long-term prognosis, adverse left vetricular remodeling and relationship with microvascular obstruction.
Int J Cardiol 2013
Amy M.
West,
C.M.
Kramer Cardiovascular Magnetic Resonance Imaging of Myocardail Infarction,
Viability,
and Cardiomyopathies.
Curr Probl Cardiol.
2010
