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^*

^*Corresponding author for this work

Clinic of Internal Medicine II - Cardiology

University of Leipzig

55 Citations (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.

Original language	English
Journal	European Radiology
Volume	24
Issue number	12
Pages (from-to)	3277-3288
Number of pages	12
ISSN	0938-7994
DOIs	https://doi.org/10.1007/s00330-014-3318-3
Publication status	Published - 14.11.2014

Research Areas and Centers

Centers: Cardiological Center Luebeck (UHZL)

DFG Research Classification Scheme

205-12 Cardiology, Angiology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1007/s00330-014-3318-3

Cite this

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

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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",

note = "Publisher Copyright: {\textcopyright} 2014, The Author(s).",

year = "2014",

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

language = "English",

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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, vol. 24, no. 12, pp. 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, Vol. 24, No. 12, 14.11.2014, p. 3277-3288.

Research output: Journal Articles › Journal articles › Research › peer-review

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 - http://www.scopus.com/inward/record.url?scp=84911811943&partnerID=8YFLogxK

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 -

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

Abstract

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