Relationship Between Progressive Microvascular Damage and Intramyocardial Hemorrhage in Patients With Reperfused Anterior Myocardial Infarction
- 15 July 1997
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation
- Vol. 96 (2), 448-453
- https://doi.org/10.1161/01.cir.96.2.448
Abstract
Background Recent studies indicated that ischemic microvascular damage may be reversible or progressive after coronary reflow. Intramyocardial hemorrhage is a phenomenon that reflects severe microvascular injury. We examined the relationship between temporal changes in microvascular perfusion patterns detected by myocardial contrast echocardiography (MCE) and intramyocardial hemorrhage detected by magnetic resonance imaging (MRI) in patients with acute myocardial infarction (AMI). Methods and Results The study population consisted of 24 patients with anterior AMI. All patients underwent MCE shortly after reflow and in the chronic stage (a mean of 31 days after reflow). Wall motion score (WMS) was determined as the sum of 16 segmental scores (dyskinetic/akinetic=3 to normal=0) at days 1 and 31. Gradient-echo acquisition and gadolinium-DTPA–enhanced spin-echo MRI were performed within 10 days after reflow. In MCE shortly after reflow, 16 patients (67%) showed contrast enhancement and the other 8 patients (33%) showed a sizable contrast defect. In the chronic stage, a persistent contrast defect was observed in 7 of 8 patients with a contrast defect shortly after reflow. Consistent contrast enhancement was observed in 12 of 16 patients (75%) with contrast enhancement shortly after reflow, indicating that a contrast defect newly appeared in 4 patients (25%). Intramyocardial hemorrhage was detected in 9 patients (38%): 5 of 7 patients with a persistent contrast defect and in all 4 patients with a new appearance of a contrast defect during the chronic stage. The patients without hemorrhage showed a significant improvement in WMS compared with patients with hemorrhage at day 31 (5±5 versus 19±6, P <.0005). Conclusions These results suggest that irreversible microvascular damage to the ischemic myocardium may cause intramyocardial hemorrhage after reflow, associated with impaired recovery of left ventricular function. Contrast enhancement within the risk area shortly after reflow does not necessarily indicate long-term microvascular salvage.Keywords
This publication has 17 references indexed in Scilit:
- Myocardial salvage: Its assessment and prediction by the analysis of serial myocardial contrast echocardiograms in patients with acute myocardial infarctionAmerican Heart Journal, 1994
- The time course of restoration of nutritive perfusion, myocardial oxygen consumption, and regional function after coronary thrombolysisCoronary Artery Disease, 1990
- Progressive failure of coronary flow during reperfusion of myocardial infarction: Documentation of the no reflow phenomenon with positron emission tomographyJournal of the American College of Cardiology, 1990
- Assessment of regional myocardial blood flow with myocardial contrast two-dimensional echocardiographyJournal of the American College of Cardiology, 1989
- Effect of Intravenous Streptokinase on Left Ventricular Function and Early Survival after Acute Myocardial InfarctionNew England Journal of Medicine, 1987
- Status of the myocardium and infarct-related coronary artery in 19 necropsy patients with acute recanalization using pharmacologic (streptokinase, r-tissue plasminogen activator), mechanical (percutaneous transluminal coronary angioplasty) or combined types of reperfusion therapyJournal of the American College of Cardiology, 1987
- Contrast echocardiography in acute myocardial ischemia. II. The effect of site of injection of contrast agent on the estimation of area at risk for necrosis after coronary occlusionJournal of the American College of Cardiology, 1985
- Time course of functional and biochemical recovery of myocardium salvaged by reperfusionJournal of the American College of Cardiology, 1983
- The “No-Reflow” Phenomenon after Temporary Coronary Occlusion in the DogJCI Insight, 1974
- Deleterious effects due to hemorrhage after myocardial reperfusionThe American Journal of Cardiology, 1974