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Published on: October 14, 2016
Temporal Evolution of Myocardial Hemorrhage and Edema in Patients After Acute ST-Segment Elevation Myocardial
David Carrick1, Caroline Haig2, Nadeem Ahmed3
1BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK Robertson Center for Biostatistics, University of Glasgow, UK.
Insights
Myocardial hemorrhage and edema after ST-elevation myocardial infarction show unimodal patterns. Hemorrhage is a key prognostic factor and therapeutic target for preserving vascular integrity post-reperfusion.
Area of Science:
- Cardiology
- Radiology
- Biomedical Imaging
Background:
- The temporal dynamics and interrelations of myocardial hemorrhage and edema post-acute ST-segment elevation myocardial infarction (STEMI) require clarification.
- Understanding these patterns is crucial for assessing infarct healing and guiding therapeutic strategies.
Purpose of the Study:
- To investigate the time course and characteristics of myocardial hemorrhage and edema following STEMI treated with primary percutaneous coronary intervention.
- To determine the prognostic significance of myocardial hemorrhage and its impact on left ventricular remodeling.
Main Methods:
- Cardiac magnetic resonance imaging (CMR) was performed on 30 STEMI patients at 4-12 hours, 3 days, 10 days, and 7 months post-reperfusion.
- Myocardial edema (T2) and hemorrhage (T2*) were quantified in remote and infarct zones.
- Hemorrhage was defined as a T2* value <20 ms, representing the infarct core.
Main Results:
- Myocardial hemorrhage followed a unimodal temporal pattern, observed in 23% to 43% of patients within the first 10 days.
- Myocardial edema generally exhibited a unimodal pattern, but a bimodal pattern was observed in patients with hemorrhage.
- Left ventricular end-diastolic volume increased significantly over 7 months in patients with hemorrhage, indicating adverse remodeling.
Conclusions:
- Myocardial hemorrhage and edema display distinct temporal evolutions, with hemorrhage being a significant prognostic indicator.
- The presence of myocardial hemorrhage influences infarct zone edema patterns and is associated with adverse left ventricular remodeling.
- Myocardial hemorrhage represents a potential therapeutic target for interventions aimed at preserving vascular integrity after coronary reperfusion.
Background:
The time course and relationships of myocardial hemorrhage and edema in patients after acute ST-segment elevation myocardial infarction (STEMI) are uncertain.
Methods And Results:
Patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention underwent cardiac magnetic resonance imaging on 4 occasions: at 4 to 12 hours, 3 days, 10 days, and 7 months after reperfusion. Myocardial edema (native T2) and hemorrhage (T2*) were measured in regions of interest in remote and injured myocardium. Myocardial hemorrhage was taken to represent a hypointense infarct core with a T2* value <20 ms. Thirty patients with ST-segment elevation myocardial infarction (mean age 54 years; 25 [83%] male) gave informed consent. Myocardial hemorrhage occurred in 7 (23%), 13 (43%), 11 (33%), and 4 (13%) patients at 4 to 12 hours, 3 days, 10 days, and 7 months, respectively, consistent with a unimodal pattern. The corresponding median amounts of myocardial hemorrhage (percentage of left ventricular mass) during the first 10 days after myocardial infarction were 2.7% (interquartile range [IQR] 0.0-5.6%), 7.0% (IQR 4.9-7.5%), and 4.1% (IQR 2.6-5.5%; P<0.001). Similar unimodal temporal patterns were observed for myocardial edema (percentage of left ventricular mass) in all patients (P=0.001) and for infarct zone edema (T2, in ms: 62.1 [SD 2.9], 64.4 [SD 4.9], 65.9 [SD 5.3]; P<0.001) in patients without myocardial hemorrhage. Alternatively, in patients with myocardial hemorrhage, infarct zone edema was reduced at day 3 (T2, in ms: 51.8 [SD 4.6]; P<0.001), depicting a bimodal pattern. Left ventricular end-diastolic volume increased from baseline to 7 months in patients with myocardial hemorrhage (P=0.001) but not in patients without hemorrhage (P=0.377).
Conclusions:
The temporal evolutions of myocardial hemorrhage and edema are unimodal, whereas infarct zone edema (T2 value) has a bimodal pattern. Myocardial hemorrhage is prognostically important and represents a target for therapeutic interventions that are designed to preserve vascular integrity following coronary reperfusion.
Clinical Trial Registration:
URL: https://clinicaltrials.gov/. Unique identifier: NCT02072850.
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