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Updated: Apr 24, 2026
Post-Myocardial Infarction Heart Failure in Closed-chest Coronary Occlusion/Reperfusion Model in Göttingen Minipigs and Landrace Pigs
Published on: April 17, 2021
Effect of infarct severity on regional and global left ventricular remodeling in patients with successfully
Rolf Symons1, Pier Giorgio Masci, Kaatje Goetschalckx
1From the Departments of Radiology (R.S., K.D., J.B.) and Cardiovascular Diseases (K.G., S.J.), Gasthuisberg University Hospital, Herestraat 49, Leuven BR 3000, Belgium; and Department of Cardiology, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy (P.G.M.).
Purpose:
To evaluate the relationship between myocardial infarction ( MI myocardial infarction ) severity at magnetic resonance (MR) imaging and regional and global postinfarction left ventricular ( LV left ventricular ) remodeling.
Materials And Methods:
This HIPAA-compliant study was institutional review board approved. In 186 patients, reperfused ST segment elevation MI myocardial infarction (mean age ± standard deviation, 59 years ± 11) was prospectively studied the first week and 4 months after infarction. Microvascular obstruction ( MVO microvascular obstruction ) and intramyocardial hemorrhage ( IMH intramyocardial hemorrhage ) helped define three infarct severity groups: S0, no MVO microvascular obstruction or IMH intramyocardial hemorrhage (n = 68); S1, MVO microvascular obstruction , no IMH intramyocardial hemorrhage (n = 84); and S2, MVO microvascular obstruction and IMH intramyocardial hemorrhage (n = 34).
Results:
were compared in 40 control patients (mean age, 58 years ± 10). One-way analysis of variance or Kruskal-Wallis test with post hoc Bonferroni correction was used. Follow-up analysis was performed with paired Student t test or Mann-Whitney U test. Results Infarct severity was positively related (P < .001) to peak of troponin I, inflammatory biomarkers, area at risk, and infarct volume and inversely related to myocardial salvage ratio, systolic wall thickening ( SWT systolic wall thickening ) in the infarct, and adjacent myocardium and LV left ventricular ejection fraction ( EF ejection fraction ). At follow-up, LV left ventricular EF ejection fraction significantly improved in S0 and S1 (S0: 53% ± 8 to 56% ± 8, P < .001; S1: 48% ± 8 to 52% ± 10, P = .006), while S2 adversely remodeled with increase in LV left ventricular end-diastolic (175 mL ± 35 to 201 mL ± 40) and end-systolic (100 mL ± 24 to 115 mL ± 29) volumes (P < .001). SWT systolic wall thickening recovery in the infarct (S0: 32% ± 21 to 42% ± 24, P < .001; S1: 19% ± 13 to 29% ± 19, P < .001; S2: 11% ± 9 to 15% ± 15, P = .22) and adjacent (S0: 41% ± 19 to 52% ± 21, P < .001; S1: 32% ± 11 to 38% ± 16, P = .002; S2: 24% ± 13 to 29% ± 14, P = .092) and remote (S0: 54% ± 18 to 62% ± 20, P = .002; S1: 53% ± 18 to 57% ± 20, P = .092; S2: 50% ± 35 to 53% ± 22, P = .75) myocardium was related to infarct severity. LV left ventricular wall thinning with LV left ventricular mass decrease occurred at follow-up (S0: 110 g ± 27 to 100 g ± 27, P < .001; S1: 115 g ± 24 to 109 g ± 26, P = .019; S2: 134 g ± 35 to 117 g ± 27, P = .043).
Conclusion:
MVO microvascular obstruction and IMH intramyocardial hemorrhage significantly affect postinfarct myocardial and LV left ventricular remodeling; hemorrhagic infarcts behave worse than nonhemorrhagic infarcts, with lack of functional recovery and adverse LV left ventricular remodeling extending to remote myocardium.
Insights
Myocardial infarction (MI) severity, indicated by microvascular obstruction and intramyocardial hemorrhage, significantly impacts left ventricular remodeling. Hemorrhagic infarcts show worse outcomes and impaired functional recovery compared to non-hemorrhagic ones.
Area of Science:
- Cardiology
- Medical Imaging
- Pathophysiology
Background:
- Left ventricular (LV) remodeling is a critical determinant of outcomes after myocardial infarction (MI).
- Magnetic resonance (MR) imaging offers detailed insights into myocardial tissue characteristics and LV function.
- Understanding the factors influencing post-MI remodeling is crucial for developing targeted therapeutic strategies.
Purpose of the Study:
- To investigate the association between the severity of myocardial infarction (MI), as assessed by MR imaging, and subsequent regional and global left ventricular (LV) remodeling.
- To differentiate the remodeling patterns based on the presence of microvascular obstruction (MVO) and intramyocardial hemorrhage (IMH).
Main Methods:
- Prospective study of 186 patients with ST-elevation MI, assessed with MR imaging in the first week and 4 months post-infarction.
- Patients categorized into three infarct severity groups (S0, S1, S2) based on MVO and IMH presence.
- Statistical analyses included ANOVA, Kruskal-Wallis, and t-tests to compare biomarkers, infarct characteristics, and LV remodeling parameters.
Main Results:
- Infarct severity correlated positively with troponin I, inflammatory biomarkers, area at risk, and infarct volume.
- LV ejection fraction improved in patients without MVO/IMH (S0) and with MVO only (S1), but not in those with both (S2).
- Group S2 exhibited adverse LV remodeling, including increased LV volumes and impaired systolic wall thickening recovery, even in remote myocardium.
Conclusions:
- Microvascular obstruction (MVO) and intramyocardial hemorrhage (IMH) significantly influence post-MI myocardial and LV remodeling.
- Hemorrhagic infarcts (IMH present) demonstrate poorer outcomes, characterized by a lack of functional recovery and adverse remodeling.
- These findings highlight the detrimental impact of hemorrhage on LV remodeling and function, extending to remote myocardial segments.
