Myocardial abnormalities underlying persistent ST-segment elevation after anterior myocardial infarction.
Massimo Napodano1, Giuseppe Tarantini, Angelo Ramondo
1Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy. massimo.napodano@gmail.com
Journal of Cardiovascular Medicine (Hagerstown, Md.)
|January 16, 2009
Summary
Persistent ST-segment elevation after myocardial infarction is linked to microvascular damage. This contrast-enhanced MRI study found microvascular damage to be the strongest predictor of this ECG finding.
Area of Science:
- Cardiology
- Medical Imaging
- Pathophysiology
Background:
- Persistent ST-segment elevation post-myocardial infarction (MI) is often linked to left ventricular aneurysm.
- The underlying pathophysiological mechanisms require further elucidation.
Purpose of the Study:
- To investigate myocardial structural and functional abnormalities associated with persistent ST-segment elevation after MI.
- Utilize contrast-enhanced magnetic resonance imaging (CE-MRI) to assess these abnormalities.
Main Methods:
- Forty patients with a first anterior MI treated with primary angioplasty underwent CE-MRI.
- Persistent ST-segment elevation was defined as ≥2 mm elevation in ≥2 leads on predischarge ECG.
- CE-MRI assessed infarct size, transmural necrosis, microvascular damage, and wall motion abnormalities.
Main Results:
- Patients with persistent ST-segment elevation exhibited larger infarct size index and more frequent transmural necrosis.
- Persistent microvascular damage was significantly more prevalent in patients with ST-segment elevation (P=0.003).
- Multivariate analysis identified persistent microvascular damage as the sole independent predictor (OR 3.13, P=0.01).
Conclusions:
- Persistent ST-segment elevation after anterior MI correlates with increased transmural necrosis and microvascular damage.
- Persistent microvascular damage is the most significant determinant of persistent ST-segment elevation.
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