Predictors of Intramyocardial Hemorrhage After Reperfused ST-Segment Elevation Myocardial Infarction.

Findings from recent studies show that microvascular injury consists of microvascular destruction and intramyocardial hemorrhage (IMH). Patients with ST-segment elevation myocardial infarction (STEMI) with IMH show poorer prognoses than patients without IMH. Knowledge on predictors for the occurrence of IMH after STEMI is lacking. The current study aimed to investigate the prevalence and extent of IMH in patients with STEMI and its relation with periprocedural and clinical variables. A multicenter observational cohort study was performed in patients with successfully reperfused STEMI with cardiovascular magnetic resonance examination 5.5±1.8 days after percutaneous coronary intervention. Microvascular injury was visualized using late gadolinium enhancement and T2-weighted cardiovascular magnetic resonance imaging for microvascular obstruction and IMH, respectively. The median was used as the cutoff value to divide the study population with presence of IMH into mild or extensive IMH. Clinical and periprocedural parameters were studied in relation to occurrence of IMH and extensive IMH, respectively. Of the 410 patients, 54% had IMH. The presence of IMH was independently associated with anterior infarction (odds ratio, 2.96; 95% CI, 1.73-5.06 [P<0.001]) and periprocedural glycoprotein IIb/IIIa inhibitor treatment (odds ratio, 2.67; 95% CI, 1.49-4.80 [P<0.001]). Extensive IMH was independently associated with anterior infarction (odds ratio, 3.76; 95% CI, 1.91-7.43 [P<0.001]). Presence and extent of IMH was associated with larger infarct size, greater extent of microvascular obstruction, larger left ventricular dimensions, and lower left ventricular ejection fraction (all P<0.001). Occurrence of IMH was associated with anterior infarction and glycoprotein IIb/IIIa inhibitor treatment. Extensive IMH was associated with anterior infarction. IMH was associated with more severe infarction and worse short-term left ventricular function in patients with STEMI.

Amier RP ，Tijssen RYG ，Teunissen PFA ，Fernández-Jiménez R ，Pizarro G ，García-Lunar I ，Bastante T ，van de Ven PM ，Beek AM ，Smulders MW ，Bekkers SCAM ，van Royen N ，Ibanez B ，Nijveldt R ... -  《Journal of the American Heart Association》

The role of left ventricular deformation in the assessment of microvascular obstruction and intramyocardial haemorrhage.

Garg P ，Kidambi A ，Swoboda PP ，Foley JR ，Musa TA ，Ripley DP ，Erhayiem B ，Dobson LE ，McDiarmid AK ，Fent GJ ，Haaf P ，Greenwood JP ，Plein S ... -  《-》

Prognostic value and clinical predictors of intramyocardial hemorrhage measured by CMR T2* sequences in STEMI.

Ferré-Vallverdú M ，Sánchez-Lacuesta E ，Plaza-López D ，Díez-Gil JL ，Sepúlveda-Sanchis P ，Gil-Cayuela C ，Maceira-Gonzalez A ，Miró-Palau V ，Montero-Argudo A ，Martínez-Dolz L ，Igual-Muñoz B ... -  《-》

Left ventricular functional recovery of infarcted and remote myocardium after ST-segment elevation myocardial infarction (METOCARD-CNIC randomized clinical trial substudy).

Podlesnikar T ，Pizarro G ，Fernández-Jiménez R ，Montero-Cabezas JM ，Greif N ，Sánchez-González J ，Bucciarelli-Ducci C ，Marsan NA ，Fras Z ，Bax JJ ，Fuster V ，Ibáñez B ，Delgado V ... -  《-》

Residual Myocardial Iron Following Intramyocardial Hemorrhage During the Convalescent Phase of Reperfused ST-Segment-Elevation Myocardial Infarction and Adverse Left Ventricular Remodeling.

The presence of intramyocardial hemorrhage (IMH) in ST-segment-elevation myocardial infarction patients reperfused by primary percutaneous coronary intervention has been associated with residual myocardial iron at follow-up, and its impact on adverse left ventricular (LV) remodeling is incompletely understood and is investigated here. Forty-eight ST-segment-elevation myocardial infarction patients underwent cardiovascular magnetic resonance at 4±2 days post primary percutaneous coronary intervention, of whom 40 had a follow-up scan at 5±2 months. Native T1, T2, and T2* maps were acquired. Eight out of 40 (20%) patients developed adverse LV remodeling. A subset of 28 patients had matching T2* maps, of which 15/28 patients (54%) had IMH. Eighteen of 28 (64%) patients had microvascular obstruction on the acute scan, of whom 15/18 (83%) patients had microvascular obstruction with IMH. On the follow-up scan, 13/15 patients (87%) had evidence of residual iron within the infarct zone. Patients with residual iron had higher T2 in the infarct zone surrounding the residual iron when compared with those without. In patients with adverse LV remodeling, T2 in the infarct zone surrounding the residual iron was also higher than in those without (60 [54-64] ms versus 53 [51-56] ms; P=0.025). Acute myocardial infarct size, extent of microvascular obstruction, and IMH correlated with the change in LV end-diastolic volume (Pearson's rho of 0.64, 0.59, and 0.66, respectively; P=0.18 and 0.62, respectively, for correlation coefficient comparison) and performed equally well on receiver operating characteristic curve for predicting adverse LV remodeling (area under the curve: 0.99, 0.94, and 0.95, respectively; P=0.19 for receiver operating characteristic curve comparison). The majority of ST-segment-elevation myocardial infarction patients with IMH had residual myocardial iron at follow-up. This was associated with persistently elevated T2 values in the surrounding infarct tissue and adverse LV remodeling. IMH and residual myocardial iron may be potential therapeutic targets for preventing adverse LV remodeling in reperfused ST-segment-elevation myocardial infarction patients.

Bulluck H ，Rosmini S ，Abdel-Gadir A ，White SK ，Bhuva AN ，Treibel TA ，Fontana M ，Ramlall M ，Hamarneh A ，Sirker A ，Herrey AS ，Manisty C ，Yellon DM ，Kellman P ，Moon JC ，Hausenloy DJ ... -  《-》