The relation between hypointense core, microvascular obstruction and intramyocardial haemorrhage in acute reperfused myocardial infarction assessed by cardiac magnetic resonance imaging

Diana Kandler; Christian Lücke; Matthias Grothoff; Claudia Andres; Lukas Lehmkuhl; Stefan Nitzsche; Franziska Riese; Meinhard Mende; Suzanne de Waha; Steffen Desch; Philipp Lurz; Ingo Eitel; Matthias Gutberlet

doi:10.1007/s00330-014-3318-3

The relation between hypointense core, microvascular obstruction and intramyocardial haemorrhage in acute reperfused myocardial infarction assessed by cardiac magnetic resonance imaging

Diana Kandler, Christian Lücke, Matthias Grothoff, Claudia Andres, Lukas Lehmkuhl, Stefan Nitzsche, Franziska Riese, Meinhard Mende, Suzanne de Waha, Steffen Desch, Philipp Lurz, Ingo Eitel, Matthias Gutberlet^*

^*Korrespondierende/r Autor/-in für diese Arbeit

Medizinische Klinik II

Universität Leipzig

67 Zitate (Scopus)

Abstract

Background: Intramyocardial haemorrhage (IMH) and microvascular obstruction (MVO) represent reperfusion injury after reperfused ST-elevation myocardial infarction (STEMI) with prognostic impact and “hypointense core” (HIC) appearance in T₂-weighted images. We aimed to distinguish between IMH and MVO by using T₂^*-weighted cardiovascular magnetic resonance imaging (CMR) and analysed influencing factors for IMH development.

Methods and results: A total of 151 patients with acute STEMI underwent CMR after primary angioplasty. T₂-STIR sequences were used to identify HIC, late gadolinium enhancement to visualise MVO and T₂^*-weighted sequences to detect IMH. IMH⁺/IMH⁻ patients were compared considering infarct size, myocardial salvage, thrombolysis in myocardial infarction (TIMI) flow, reperfusion time, ventricular volumes, function and pre-interventional medication. Seventy-six patients (50 %) were IMH⁺, 82 (54 %) demonstrated HIC and 100 (66 %) MVO. IMH was detectable without HIC in 16 %, without MVO in 5 % and HIC without MVO in 6 %. Multivariable analyses revealed that IMH was associated with significant lower left ventricular ejection fraction and myocardial salvage index, larger left ventricular volume and infarct size. Patients with TIMI flow grade ≤1 before angioplasty demonstrated IMH significantly more often.

Conclusions: IMH is associated with impaired left ventricular function and higher infarct size. T₂ and HIC imaging showed moderate agreement for IMH detection. T₂^* imaging might be the preferred CMR imaging method for comprehensive IMH assessment.

Key Points: • Intramyocardial haemorrhage is a common finding in patients with acute reperfused myocardial-infarction.

• T₂^*imaging should be the preferred CMR method for assessment of intramyocardial haemorrhage.

• Intramyocardial haemorrhage can be considered as an important influencing factor on patient’s outcome.

Originalsprache	Englisch
Zeitschrift	European Radiology
Jahrgang	24
Ausgabenummer	12
Seiten (von - bis)	3277-3288
Seitenumfang	12
ISSN	0938-7994
DOIs	https://doi.org/10.1007/s00330-014-3318-3
Publikationsstatus	Veröffentlicht - 14.11.2014

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Dieser Output leistet einen Beitrag zu folgendem(n) Ziel(en) für nachhaltige Entwicklung

SDG 3 – Gesundheit und Wohlergehen

Strategische Forschungsbereiche und Zentren

Zentren: Universitäres Herzzentrum Lübeck (UHZL)

DFG-Fachsystematik

2.22-12 Kardiologie, Angiologie

Dokumente

10.1007/s00330-014-3318-3

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Kandler, D., Lücke, C., Grothoff, M., Andres, C., Lehmkuhl, L., Nitzsche, S., Riese, F., Mende, M., de Waha, S., Desch, S., Lurz, P., Eitel, I., & Gutberlet, M. (2014). The relation between hypointense core, microvascular obstruction and intramyocardial haemorrhage in acute reperfused myocardial infarction assessed by cardiac magnetic resonance imaging. European Radiology, 24(12), 3277-3288. https://doi.org/10.1007/s00330-014-3318-3

@article{563aaef2b1644d86bb48010875cde76d,

title = "The relation between hypointense core, microvascular obstruction and intramyocardial haemorrhage in acute reperfused myocardial infarction assessed by cardiac magnetic resonance imaging",

abstract = "Background: Intramyocardial haemorrhage (IMH) and microvascular obstruction (MVO) represent reperfusion injury after reperfused ST-elevation myocardial infarction (STEMI) with prognostic impact and “hypointense core” (HIC) appearance in T2-weighted images. We aimed to distinguish between IMH and MVO by using T2*-weighted cardiovascular magnetic resonance imaging (CMR) and analysed influencing factors for IMH development.Methods and results: A total of 151 patients with acute STEMI underwent CMR after primary angioplasty. T2-STIR sequences were used to identify HIC, late gadolinium enhancement to visualise MVO and T2*-weighted sequences to detect IMH. IMH+/IMH− patients were compared considering infarct size, myocardial salvage, thrombolysis in myocardial infarction (TIMI) flow, reperfusion time, ventricular volumes, function and pre-interventional medication. Seventy-six patients (50 \%) were IMH+, 82 (54 \%) demonstrated HIC and 100 (66 \%) MVO. IMH was detectable without HIC in 16 \%, without MVO in 5 \% and HIC without MVO in 6 \%. Multivariable analyses revealed that IMH was associated with significant lower left ventricular ejection fraction and myocardial salvage index, larger left ventricular volume and infarct size. Patients with TIMI flow grade ≤1 before angioplasty demonstrated IMH significantly more often.Conclusions: IMH is associated with impaired left ventricular function and higher infarct size. T2 and HIC imaging showed moderate agreement for IMH detection. T2* imaging might be the preferred CMR imaging method for comprehensive IMH assessment.Key Points: • Intramyocardial haemorrhage is a common finding in patients with acute reperfused myocardial-infarction.• T2*imaging should be the preferred CMR method for assessment of intramyocardial haemorrhage.• Intramyocardial haemorrhage can be considered as an important influencing factor on patient{\textquoteright}s outcome.",

author = "Diana Kandler and Christian L{\"u}cke and Matthias Grothoff and Claudia Andres and Lukas Lehmkuhl and Stefan Nitzsche and Franziska Riese and Meinhard Mende and \{de Waha\}, Suzanne and Steffen Desch and Philipp Lurz and Ingo Eitel and Matthias Gutberlet",

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year = "2014",

month = nov,

day = "14",

doi = "10.1007/s00330-014-3318-3",

language = "English",

volume = "24",

pages = "3277--3288",

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Kandler, D, Lücke, C, Grothoff, M, Andres, C, Lehmkuhl, L, Nitzsche, S, Riese, F, Mende, M, de Waha, S, Desch, S, Lurz, P, Eitel, I & Gutberlet, M 2014, 'The relation between hypointense core, microvascular obstruction and intramyocardial haemorrhage in acute reperfused myocardial infarction assessed by cardiac magnetic resonance imaging', European Radiology, Jg. 24, Nr. 12, S. 3277-3288. https://doi.org/10.1007/s00330-014-3318-3

The relation between hypointense core, microvascular obstruction and intramyocardial haemorrhage in acute reperfused myocardial infarction assessed by cardiac magnetic resonance imaging. / Kandler, Diana; Lücke, Christian; Grothoff, Matthias et al.
in: European Radiology, Jahrgang 24, Nr. 12, 14.11.2014, S. 3277-3288.

Publikation: Beiträge in Fachzeitschriften › Zeitschriftenaufsätze › Forschung › Begutachtung

TY - JOUR

T1 - The relation between hypointense core, microvascular obstruction and intramyocardial haemorrhage in acute reperfused myocardial infarction assessed by cardiac magnetic resonance imaging

AU - Kandler, Diana

AU - Lücke, Christian

AU - Grothoff, Matthias

AU - Andres, Claudia

AU - Lehmkuhl, Lukas

AU - Nitzsche, Stefan

AU - Riese, Franziska

AU - Mende, Meinhard

AU - de Waha, Suzanne

AU - Desch, Steffen

AU - Lurz, Philipp

AU - Eitel, Ingo

AU - Gutberlet, Matthias

PY - 2014/11/14

Y1 - 2014/11/14

N2 - Background: Intramyocardial haemorrhage (IMH) and microvascular obstruction (MVO) represent reperfusion injury after reperfused ST-elevation myocardial infarction (STEMI) with prognostic impact and “hypointense core” (HIC) appearance in T2-weighted images. We aimed to distinguish between IMH and MVO by using T2*-weighted cardiovascular magnetic resonance imaging (CMR) and analysed influencing factors for IMH development.Methods and results: A total of 151 patients with acute STEMI underwent CMR after primary angioplasty. T2-STIR sequences were used to identify HIC, late gadolinium enhancement to visualise MVO and T2*-weighted sequences to detect IMH. IMH+/IMH− patients were compared considering infarct size, myocardial salvage, thrombolysis in myocardial infarction (TIMI) flow, reperfusion time, ventricular volumes, function and pre-interventional medication. Seventy-six patients (50 %) were IMH+, 82 (54 %) demonstrated HIC and 100 (66 %) MVO. IMH was detectable without HIC in 16 %, without MVO in 5 % and HIC without MVO in 6 %. Multivariable analyses revealed that IMH was associated with significant lower left ventricular ejection fraction and myocardial salvage index, larger left ventricular volume and infarct size. Patients with TIMI flow grade ≤1 before angioplasty demonstrated IMH significantly more often.Conclusions: IMH is associated with impaired left ventricular function and higher infarct size. T2 and HIC imaging showed moderate agreement for IMH detection. T2* imaging might be the preferred CMR imaging method for comprehensive IMH assessment.Key Points: • Intramyocardial haemorrhage is a common finding in patients with acute reperfused myocardial-infarction.• T2*imaging should be the preferred CMR method for assessment of intramyocardial haemorrhage.• Intramyocardial haemorrhage can be considered as an important influencing factor on patient’s outcome.

AB - Background: Intramyocardial haemorrhage (IMH) and microvascular obstruction (MVO) represent reperfusion injury after reperfused ST-elevation myocardial infarction (STEMI) with prognostic impact and “hypointense core” (HIC) appearance in T2-weighted images. We aimed to distinguish between IMH and MVO by using T2*-weighted cardiovascular magnetic resonance imaging (CMR) and analysed influencing factors for IMH development.Methods and results: A total of 151 patients with acute STEMI underwent CMR after primary angioplasty. T2-STIR sequences were used to identify HIC, late gadolinium enhancement to visualise MVO and T2*-weighted sequences to detect IMH. IMH+/IMH− patients were compared considering infarct size, myocardial salvage, thrombolysis in myocardial infarction (TIMI) flow, reperfusion time, ventricular volumes, function and pre-interventional medication. Seventy-six patients (50 %) were IMH+, 82 (54 %) demonstrated HIC and 100 (66 %) MVO. IMH was detectable without HIC in 16 %, without MVO in 5 % and HIC without MVO in 6 %. Multivariable analyses revealed that IMH was associated with significant lower left ventricular ejection fraction and myocardial salvage index, larger left ventricular volume and infarct size. Patients with TIMI flow grade ≤1 before angioplasty demonstrated IMH significantly more often.Conclusions: IMH is associated with impaired left ventricular function and higher infarct size. T2 and HIC imaging showed moderate agreement for IMH detection. T2* imaging might be the preferred CMR imaging method for comprehensive IMH assessment.Key Points: • Intramyocardial haemorrhage is a common finding in patients with acute reperfused myocardial-infarction.• T2*imaging should be the preferred CMR method for assessment of intramyocardial haemorrhage.• Intramyocardial haemorrhage can be considered as an important influencing factor on patient’s outcome.

UR - https://www.scopus.com/pages/publications/84911811943

U2 - 10.1007/s00330-014-3318-3

DO - 10.1007/s00330-014-3318-3

M3 - Journal articles

C2 - 25097126

AN - SCOPUS:84911811943

SN - 0938-7994

VL - 24

SP - 3277

EP - 3288

JO - European Radiology

JF - European Radiology

IS - 12

ER -