Intramyocardial dissecting hematoma in anterior wall ST elevation myocardial infarction: impact on left ventricular remodeling and prognosis

  • Letizia Spinelli
  • Eugenio Stabile
  • Giuseppe Giugliano
  • Carmine Morisco
  • Caterina Anna Giudice
  • Massimo Imbriaco
  • Mario Santoro
  • Giovanni Esposito
  • Bruno Trimarco
Original Paper

Abstract

Intramyocardial dissecting hematoma is an uncommon complication of myocardial infarction potentially leading to cardiac rupture. The aim of the present study was to investigate coronary reperfusion results, left ventricular (LV) function recovery and remodeling and clinical outcomes in patients with anterior STEMI complicated by intramyocardial hematoma. We prospectively studied 87 patients (mean age 59 ± 10 years; 88% male) with anterior STEMI (42 with intramyocardial hematoma) in order to evaluate coronary reperfusion results, LV remodeling (≥15% increase in end-systolic volume) and clinical outcomes (cardiac death, non-fatal reinfarction, and hospitalization for congestive heart failure) at 24 months. Thrombolysis in myocardial infarction (TIMI) flow score and myocardial blush grade (MBG) were assessed both pre- and post-percutaneous coronary intervention (PCI) and speckle-tracking echocardiography was performed post PCI and at 6-month follow-up. Patients with hematoma had lower post-PCI TIMI score and MBG, higher heart rate, worse LV ejection fraction and longitudinal or rotational function than their counterparts. LV remodeling occurred in 33 (78.6%) patients with hematoma and 11 (24.4%) patients without (p < 0.001). Independent predictors of LV remodeling were heart rate (p = 0.018), MBG (p = 0.036) and presence of hematoma (p < 0.001). Hematoma (log-rank test, χ2 = 9.849; p = 0.002) and LV remodeling (log-rank test, χ2 = 13.770; p < 0.001) were associated to a higher rate of adverse events. Cox analysis identified LV remodeling as the only independent predictor of adverse events (hazard ratio = 3.912; 95% confidence interval, 1.429–10.714; p = 0.008). Intramyocardial dissecting hematoma complicating anterior STEMI is an independent determinant of LV remodeling and is associated to poor prognosis.

Keywords

Intramyocardial hematoma Left ventricular remodeling Speckle-tracking echocardiography ST-segment elevation myocardial infarction Cardiovascular event 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interes.

Supplementary material

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Copyright information

© Springer Science+Business Media B.V. 2017

Authors and Affiliations

  • Letizia Spinelli
    • 1
  • Eugenio Stabile
    • 1
  • Giuseppe Giugliano
    • 1
  • Carmine Morisco
    • 1
  • Caterina Anna Giudice
    • 2
  • Massimo Imbriaco
    • 1
  • Mario Santoro
    • 2
  • Giovanni Esposito
    • 1
  • Bruno Trimarco
    • 1
  1. 1.Department of Advanced Biomedical SciencesFederico II UniversityNaplesItaly
  2. 2.Department of Translational Medical SciencesFederico II UniversityNaplesItaly

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