Correlation of Serial Cardiac Magnetic Resonance Imaging Parameters With Early Resolution of ST-Segment Elevation After Primary Percutaneous Coronary Intervention

Abstract

mong the many markers used to assess successful myocardial reperfusion after primary percutaneous coronary intervention (PCI) or thrombolysis therapy, the extent of resolution of ST-segment elevation is a simple noninvasive indicator of the outcome of infarcted myocardium. 1 Previous studies using myocardial contrast echocardiography 2,3 or radioisotope scintigraphy [4][5][6] have demonstrated that early ST-segment elevation resolution (STR) after primary PCI or thrombolysis is associated with better salvage of reperfused myocardium. However, both the pathologic correlates and the mechanisms of early STR are relatively unknown. Recent advances in cardiac magnetic resonance imaging (CMRI) allow relatively precise assessments of myocardial perfusion, infarct size, left ventricular (LV) remodeling and function, with excellent correlation with histology in animal models of acute and chronic myocardial infarction (MI). 7,8 However, there are little data on the CMRI findings related to early STR after successful Circulation Journal Vol.72, October 2008 primary PCI. Therefore, we performed CMRI serially in the early and late phases after successful revascularization by primary PCI for treatment of MI. We sought to determine whether the morphologic and functional parameters of CMRI correlated with early STR after primary PCI for ST-elevation myocardial infarction (STEMI). Method SubjectsWe investigated 45 patients with acute STEMI in whom primary PCI was performed successfully within 12 h of symptom onset. Diagnosis of acute MI (AMI) was based on the presence of acute ischemic chest pain, electrocardiogram (ECG) findings (ST-segment elevation ≥0.1 mV in 2 or more contiguous leads), elevated serum cardiac biomarkers (cardiac troponin T >0.1 g/L, creatine kinase-MB (CK-MB) fraction enzyme level >10 g/L), and angiographic significant stenosis (≥50%) of a coronary artery. Exclusion criteria were unstable hemodynamic status, any history of previous MI, or contraindications to CMRI (eg, pacemaker implantation or claustrophobia). We also excluded patients with recurrent chest pain or anginal equivalent associated with ST-segment changes during the time period between primary angioplasty and second CMRI. All participants gave written informed consent to the study protocol. ECG AnalysisA 12-lead ECG was performed before and 90 min after primary PCI. The sum of ST-segment elevation was mea- Correlation of Serial Cardiac Magnetic Resonance Imaging Parameters With Early Resolution of ST-Segment Elevation After Primary Percutaneous Coronary InterventionJung-Sun Kim, MD, PhD; Young-Guk Ko, MD; Se-Jung Yoon, MD, PhD*; Jae-Youn Moon, MD; Young Jin Kim, MD, PhD**; Byoung Wook Choi, MD, PhD**; Donghoon Choi, MD, PhD; Yangsoo Jang, MD, PhDBackground The aim of the present study was to determine whether the parameters of cardiac magnetic resonance imaging (CMRI) might correlate with early ST-segment resolution (STR) after primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI

Late microvascular obstruction after acute myocardial infarction: Relation with cardiac and inflammatory markers

“…Furthermore, our study is in accordance with a report suggesting that incomplete STR is strongly associated with the presence of l-MVO and that the extent of STR correlates with the l-MVO size [43]. L-MVO size in patients with STR b50% was highly significantly greater than in those with N50% or complete STR.…”

Dynamic Changes in ST Segment Resolution After Myocardial Infarction and the Association with Microvascular Injury on Cardiac Magnetic Resonance Imaging

“…Intracoronary Doppler flow measurements at four to eight days confirm a close correlation between persistent microvascular dysfunction and MVO on CMR [29]. This may explain why MVO has also shown a potent ability to predict adverse left ventricular remodeling at four to six months [18,30]. IMH, as a severe manifestation of MVO, also has been associated with larger infarct size and poor left ventricular functional recovery [25,27,31].…”

Cardiac MRI in Ischemic Heart Disease

“…69 MRI is useful for tissue characterization of reperfused MI. 70 Microvascular obstruction is revealed as an area of perfusion defect on rest perfusion MRI, indicating occlusion of capillaries at the myocardial tissue level 71,72 (Figure 6). On LGE MRI, microvascular obstruction is shown as a nonenhanced area, typically in the subendocardial layer, sur- Figure 6.…”