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European Radiology

, Volume 23, Issue 9, pp 2405–2412 | Cite as

Acute myocardial infarction: early CT aspects of myocardial microcirculation obstruction after percutaneous coronary intervention

  • Charles Amanieu
  • Ingrid Sanchez
  • Simona Arion
  • Eric Bonnefoy
  • Didier Revel
  • Philippe Douek
  • Loic BousselEmail author
Cardiac

Abstract

Objective

To evaluate the capabilities of delayed enhanced multidetector CT (DE-MDCT), performed immediately after percutaneous coronary intervention (PCI), in predicting myocardial microvascular obstruction (MVO) formation assessed by delayed enhanced MRI (DE-MRI).

Methods

Thirty-two patients presenting with a primary acute myocardial infarction, successfully recanalised by PCI, underwent a DE-MDCT immediately after PCI and a DE-MRI within 1 week. The left ventricle was split into 64 subsegments, rated as “healthy”, “infarcted” or “MVO” on DE-MRI. Their mean density was measured on DE-MDCT and calculated relative to the patient's mean healthy myocardium density. Hypoenhanced DE-MDCT subsegments, termed “CT early MVO”, were also recorded. Sensitivity and specificity of DE-MDCT for MRI-assessed “MVO” subsegments detection was calculated for mean CT relative density (threshold determined from a ROC analysis), “CT early MVO” and both.

Results

Mean CT relative density was higher in MRI-assessed “MVO” than in “infarcted” and “healthy” subsegments (1.82 ± 0.46, 1.43 ± 0.36 and 1.0 ± 0.13 respectively; P < 0.001) leading to a sensitivity and specificity of 94.3 % and 89.2 % for a cutoff of 1.36. Sensitivity and specificity were respectively 16.9 % and 99.8 % for “CT early MVO” and 95.3 % and 89.3 % when considering the two patterns.

Conclusion

DE-MDCT, performed immediately after PCI, allows for an accurate prediction of MVO formation.

Key Points

• Myocardial microvascular obstruction (MVO) is an important prognostic sequel following myocardial infarction.

• MVO can be accurately predicted by multidector CT (MDCT).

• Both hypo- and hyperenhanced myocardial areas can be analysed by MDCT.

• MDCT may become a useful prognostic tool for acute MI outcome.

Keywords

CT systems, X-Ray computed Magnetic resonance imaging Myocardial infarction Myocardial microvascular obstruction Delayed enhancement 

Abbreviations

DE-MDCT

Delayed enhanced multidetector CT

MVO

Myocardial microvascular obstruction

PCI

Percutaneous coronary intervention

DE-MRI

Delayed-enhanced magnetic resonance imaging

CK

Creatine kinase

MPR

Multiplanar reconstruction

Notes

Acknowledgements

We acknowledge Michel Ovize from the Department of Cardiology, Louis Pradel Hospital, Lyon, France, for his help with this manuscript.

References

  1. 1.
    Bolognese L, Carrabba N, Parodi G et al (2004) Impact of microvascular dysfunction on left ventricular remodeling and long-term clinical outcome after primary coronary angioplasty for acute myocardial infarction. Circulation 109:1121–1126PubMedCrossRefGoogle Scholar
  2. 2.
    Brosh D, Assali AR, Mager A et al (2007) Effect of no-reflow during primary percutaneous coronary intervention for acute myocardial infarction on six-month mortality. Am J Cardiol 99:442–445PubMedCrossRefGoogle Scholar
  3. 3.
    Cochet AA, Lorgis L, Lalande A et al (2009) Major prognostic impact of persistent microvascular obstruction as assessed by contrast-enhanced cardiac magnetic resonance in reperfused acute myocardial infarction. Eur Radiol 19:2117–2126PubMedCrossRefGoogle Scholar
  4. 4.
    Ito H, Tomooka T, Sakai N et al (1992) Lack of myocardial perfusion immediately after successful thrombolysis. A predictor of poor recovery of left ventricular function in anterior myocardial infarction. Circulation 85:1699–1705PubMedCrossRefGoogle Scholar
  5. 5.
    Wu KC, Zerhouni EA, Judd RM et al (1998) Prognostic significance of microvascular obstruction by magnetic resonance imaging in patients with acute myocardial infarction. Circulation 97:765–772PubMedCrossRefGoogle Scholar
  6. 6.
    Ambrosio G, Weisman HF, Mannisi JA, Becker LC (1989) Progressive impairment of regional myocardial perfusion after initial restoration of postischemic blood flow. Circulation 80:1846–1861PubMedCrossRefGoogle Scholar
  7. 7.
    Ito H, Maruyama A, Iwakura K et al (1996) Clinical implications of the 'no reflow' phenomenon. A predictor of complications and left ventricular remodeling in reperfused anterior wall myocardial infarction. Circulation 93:223–228PubMedCrossRefGoogle Scholar
  8. 8.
    Kloner RA, Ganote CE, Jennings RB (1974) The "no-reflow" phenomenon after temporary coronary occlusion in the dog. J Clin Invest 54:1496–1508PubMedCrossRefGoogle Scholar
  9. 9.
    Niccoli G, Burzotta F, Galiuto L, Crea F (2009) Myocardial no-reflow in humans. J Am Coll Cardiol 54:281–292PubMedCrossRefGoogle Scholar
  10. 10.
    Reffelmann T, Kloner RA (2006) The no-reflow phenomenon: a basic mechanism of myocardial ischemia and reperfusion. Basic Res Cardiol 101:359–372PubMedCrossRefGoogle Scholar
  11. 11.
    Verma S, Fedak PW, Weisel RD et al (2002) Fundamentals of reperfusion injury for the clinical cardiologist. Circulation 105:2332–2336PubMedCrossRefGoogle Scholar
  12. 12.
    Albert TS, Kim RJ, Judd RM (2006) Assessment of no-reflow regions using cardiac MRI. Basic Res Cardiol 101:383–390PubMedCrossRefGoogle Scholar
  13. 13.
    Habis M, Capderou A, Ghostine S et al (2007) Acute myocardial infarction early viability assessment by 64-slice computed tomography immediately after coronary angiography: comparison with low-dose dobutamine echocardiography. J Am Coll Cardiol 49:1178–1185PubMedCrossRefGoogle Scholar
  14. 14.
    Boussel L, Ribagnac M, Bonnefoy E et al (2008) Assessment of acute myocardial infarction using MDCT after percutaneous coronary intervention: comparison with MRI. AJR Am J Roentgenol 191:441–447PubMedCrossRefGoogle Scholar
  15. 15.
    Camilleri JP, Joseph D, Fabiani JN et al (1976) Microcirculatory changes following early reperfusion in experimental myocardial infarction. Virchows Arch A Pathol Anat Histol 369:315–333PubMedCrossRefGoogle Scholar
  16. 16.
    Cobb FR, Bache RJ, Rivas F, Greenfield JC Jr (1976) Local effects of acute cellular injury on regional myocardial blood flow. J Clin Invest 57:1359–1368PubMedCrossRefGoogle Scholar
  17. 17.
    Rochitte CE, Lima JA, Bluemke DA et al (1998) Magnitude and time course of microvascular obstruction and tissue injury after acute myocardial infarction. Circulation 98:1006–1014PubMedCrossRefGoogle Scholar
  18. 18.
    Reffelmann T, Kloner RA (2002) Microvascular reperfusion injury: rapid expansion of anatomic no reflow during reperfusion in the rabbit. Am J Physiol Heart Circ Physiol 283:H1099–H1107PubMedGoogle Scholar
  19. 19.
    Chesebro JH, Knatterud G, Roberts R et al (1987) Thrombolysis in Myocardial Infarction (TIMI) trial, phase I: a comparison between intravenous tissue plasminogen activator and intravenous streptokinase. Clinical findings through hospital discharge. Circulation 76:142–154PubMedCrossRefGoogle Scholar
  20. 20.
    Killip T 3rd, Kimball JT (1967) Treatment of myocardial infarction in a coronary care unit. A two year experience with 250 patients. Am J Cardiol 20:457–464PubMedCrossRefGoogle Scholar
  21. 21.
    Puech PA, Boussel L, Belfkih S, Lemaitre L, Douek P, Beuscart R (2007) DicomWorks: software for reviewing DICOM studies and promoting low-cost teleradiology. J Digit Imaging 20:122–130PubMedCrossRefGoogle Scholar
  22. 22.
    Cerqueira MD, Weissman NJ, Dilsizian V et al (2002) Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the cardiac imaging committee of the council on clinical cardiology of the American heart association. Circulation 105:539–542PubMedCrossRefGoogle Scholar
  23. 23.
    Jacquier A, Boussel L, Amabile N et al (2008) Multidetector computed tomography in reperfused acute myocardial infarction. Assessment of infarct size and no-reflow in comparison with cardiac magnetic resonance imaging. Invest Radiol 43:773–781PubMedCrossRefGoogle Scholar
  24. 24.
    Lardo AC, Cordeiro MA, Silva C et al (2006) Contrast-enhanced multidetector computed tomography viability imaging after myocardial infarction: characterization of myocyte death, microvascular obstruction, and chronic scar. Circulation 113:394–404PubMedCrossRefGoogle Scholar
  25. 25.
    Furtado AD, Carlsson M, Wintermark M, Ordovas K, Saeed M (2008) Identification of residual ischemia, infarction, and microvascular impairment in revascularized myocardial infarction using 64-slice MDCT. Contrast Media & Molecular Imaging 3:198–206CrossRefGoogle Scholar
  26. 26.
    Manciet LH, Poole DC, McDonagh PF, Copeland JG, Mathieu-Costello O (1994) Microvascular compression during myocardial ischemia: mechanistic basis for no-reflow phenomenon. Am J Physiol 266:1541–1550Google Scholar
  27. 27.
    Basso C, Corbetti F, Silva C et al (2007) Morphologic validation of reperfused hemorrhagic myocardial infarction by cardiovascular magnetic resonance. Am J Cardiol 100:1322–1327PubMedCrossRefGoogle Scholar
  28. 28.
    Beek AM, Nijveldt R, van Rossum AC (2010) Intramyocardial hemorrhage and microvascular obstruction after primary percutaneous coronary intervention. Int J Cardiovasc Imaging 26:49–55PubMedCrossRefGoogle Scholar
  29. 29.
    Piot C, Croisille P, Staat P et al (2008) Effect of cyclosporine on reperfusion injury in acute myocardial infarction. N Engl J Med 359:473–481PubMedCrossRefGoogle Scholar
  30. 30.
    Staat P, Rioufol G, Piot C et al (2005) Postconditioning the human heart. Circulation 112:2143–2148PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2013

Authors and Affiliations

  • Charles Amanieu
    • 1
  • Ingrid Sanchez
    • 1
  • Simona Arion
    • 1
  • Eric Bonnefoy
    • 2
  • Didier Revel
    • 1
  • Philippe Douek
    • 1
  • Loic Boussel
    • 3
    • 4
    Email author
  1. 1.Department of RadiologyLouis Pradel Hospital, CREATIS, CNRS UMR 5220, INSERM U1044LyonFrance
  2. 2.Department of CardiologyU51, Louis Pradel HospitalLyonFrance
  3. 3.Department of RadiologyCroix-Rousse Hospital, CREATIS, CNRS UMR 5220, INSERM U1044LyonFrance
  4. 4.Department of RadiologyCroix-Rousse HospitalLyonFrance

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