Fig. 17.4

Non-invasive tools to assess microvascular obstruction. (a) ST-segment resolution represents a useful tool of coronary microvascular obstruction after myocardial infarction. Black arrows showing absence of ST-segment resolution after artery recanalization. (b) Cardiac magnetic resonance. On late gadolinium enhancement, areas of microvascular obstruction are seen, hypoenhancement (so-called “dark zones”) within an avidly enhancing site of myocardial infarction. (c) Myocardial contrast echocardiography showing lack of intra-myocardial contrast opacification (indicated by white arrow). (d) Single-photon emission computed tomography showing absent tracer uptake (white arrow, scintigraphic no-reflow phenomenon), as compared to normal uptake (left position). Adapted from Adjedj, J., et al. (2018). “Coronary microcirculation in acute myocardial ischaemia: From non-invasive to invasive absolute flow assessment.” Arch Cardiovasc Dis