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Prognostic value and clinical predictors of intramyocardial hemorrhage measured by CMR T2* sequences in STEMI

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Abstract

Recent studies show that microvascular injury consists of microvascular obstruction (MVO) and intramyocardial hemorrhage (IMH). In patients with reperfused ST-segment elevation myocardial infarction (STEMI) quantitative assessment of IMH with T2* cardiovascular magnetic resonance imaging (CMR) appears to be useful in evaluation of microvascular damage. The current study aimed to investigate feasibility of this approach and to correlate IMH with clinical and CMR parameters. A single center observational cohort study was performed in reperfused STEMI patients with CMR examination 7 days (IQR: 5 to 8 days) after percutaneous coronary intervention. Infarct size (IS) and MVO were evaluated in short-axis late gadolinium enhancement sequences and IMH with whole LV volume T2* mapping sequences. Of the 94 patients, MVO was identified in 52% of patients and the median size of MVO was 3% of LV mass (IQR: 1.5 to 5.4%). IMH was present in 28% of patients and the median size of IMH was 1.1% of LV mass (IQR: 0.5 to 2.9%). IMH extent was independently associated with anterior myocardial infarction (p = 0.022) and thrombectomy (p = 0.049). IMH was correlated with MVO (R = 0.62, p < 0.001), necrosis (R = 0.58, p < 0.001) and LVEF (R = -0.21, p = 0.04). Patients with IMH presented higher incidence of MACE events, independently of LVEF (p = 0.022). T2* mapping is a novel imaging approach that proves useful to asses IMH in the setting of reperfused STEMI. T2* IMH extent was associated with anterior infarction and thrombectomy. T2* IMH was associated with higher incidence of MACE events regardless preserved or reduced LVEF.

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Data availability

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

CMR:

Cardiac magnetic resonance

IMH:

Intramyocardial hemorrhage

IS:

Infarct size

LGE:

Late gadolinium enhancement sequence

LV:

Left ventricular

LVEF:

Left ventricular ejection fraction

MACE:

Major adverse cardiovascular events

MVO:

Microvascular obstruction

PCI:

Percutaneous coronary intervention

STEMI:

ST-segment elevation myocardial infarction

TIMI:

Thrombolysis in Myocardial Infarction

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Authors and Affiliations

  1. Department of Cardiology, Hospital Universitari I Politècnic La Fe, Valencia, Spain

    Maria Ferré-Vallverdú, Elena Sánchez-Lacuesta, Diego Plaza-López, José Luis Díez-Gil, Vicente Miró-Palau & Luis Martínez-Dolz

  2. Instituto de Investigación Sanitaria La Fe, Valencia, Spain

    Pilar Sepúlveda-Sanchis & Carolina Gil-Cayuela

  3. Cardiac Imaging Unit, ERESA Medical Center, Valencia, Spain

    Alicia Maceira-Gonzalez & Begoña Igual-Muñoz

  4. Department of Cardiovascular Surgery, Hospital Universitari I Politècnic La Fe, Valencia, Spain

    Anastasio Montero-Argudo

  5. Hospital Universitari Sant Joan de Reus, Avinguda del Doctor Josep Laporte, 2, 43204, Reus, Tarragona, Spain

    Maria Ferré-Vallverdú

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  1. Maria Ferré-Vallverdú
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Contributions

MFV, ESL, BIM, designed research; MFV, ESL, DPL, JLDG, PSS, collection of data; DPL, JLDG, PSS, interpretation of data; MFV, ESL, BIM, writing the manuscript; MFV, ESL, CGC, AMG, VMP, AMA, LMD, BIM, revised the manuscript. “All authors have read and approved the manuscript”.

Corresponding author

Correspondence to Maria Ferré-Vallverdú.

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The authors declare that they have no competing interests.

Ethical approval

The study protocol was approved by the local ethics committee (Comité Ético de Investigación Clínica (CEIC) Hospital Universitari i Politècnic La Fe, Valencia). All patients gave written informed consent.

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Ferré-Vallverdú, M., Sánchez-Lacuesta, E., Plaza-López, D. et al. Prognostic value and clinical predictors of intramyocardial hemorrhage measured by CMR T2* sequences in STEMI. Int J Cardiovasc Imaging 37, 1735–1744 (2021). https://doi.org/10.1007/s10554-020-02142-7

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