Impact of microvascular injury various types on function of left ventricular in patients with primary myocardial infarction with ST segment elevation

Abstract

Aim. To analyze the long-term effect of microvascular injury various types on the structural and functional parameters of the left ventricle assessed by echocardiography in patients with primary ST-segment elevation myocardial infarction (STEMI).Materials and methods. The study included 60 patients with primary STEMI admitted within the first 12 hours after the onset of disease who underwent stenting of the infarct-associated coronary artery. Each patient included in the study underwent CMR imaging on the second day post-STEMI. MVO and IMH were assessed using late gadolinium enhancement and T2-weighted CMR imaging. Subsequently, all patients underwent the standard echocardiographic protocol on the 7th day and 3 months after MI. Results. We divided all patients into 4 groups: the 1st group didn’t have any phenomena of IMH and MVO, the 2nd group had only MVO, patients of the 3rd group had only IMH and in the 4th group there was a combination of MVO and IMH. LV ejection fraction was significantly lower in patients with combination of MVO and IMH, if compared to those without it. Correlation analysis showed a moderate inverse correlation between the MVO area and LV contractile function: the larger the area, the lower the LVEF (R=-0,60; p=0,000002).Conclusions. The combination of IMH and MVO is a predictor of a reduction in LVEF and an increase of volumetric measurements within 3 months after MI. In comparison with patients without microvascular injury isolated MVO is associated with lower LVEF. The size of MVO is directly correlated with the LV contractile function decrease. Isolated IMH was not associated with deterioration of left ventricular function.

The Role of Microvascular Obstruction and Intra-Myocardial Hemorrhage in Reperfusion Cardiac Injury. Analysis of Clinical Data

“…Microvascular obstruction was found in 25% of patients by angiography (TIMI = 0 or 2) with STEMI and PCI [ 9 ]. According to our data, the incidence of MVO is 37% in patients with STEMI and PCI by MRI data [ 66 ].…”

“…Currently, the assessment of MVO often uses both angiography and MRI (Table 1 , Ref. [ 5 , 7 , 9 , 10 , 11 , 12 , 13 , 14 , 16 , 17 , 18 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 ]). However, in recent years, investigators increasingly favor MRI as a more accurate method of assessing MVO.…”

A historical literature review of coronary microvascular obstruction and intra-myocardial hemorrhage as functional/structural phenomena

“…MVO also can be detected by the angiographic TIMI flow grade in 25% of patients with STEMI and PCI in one study [ 13 ] but in 46% of patients with STEMI and PCI by the same method in another study [ 14 ] . However, MRI data alone suggested that the incidence of MVO was 37% in patients with STEMI and PCI [ 15 ] . These data suggest that the incidence of MVO may range between 25% and 56% in patients with STEMI and PCI.…”

Reperfusion Cardiac Injury: Receptors and the Signaling Mechanisms

“…Another major problem is the no-reflow phenomenon which is observed in approximately 5% of patients with AMI and PCI [ 179 ]. However, even if we could restore coronary blood flow in the main coronary arteries, a problem of microvascular coronary obstruction occurs for which there currently is no effective treatment intervention [ 184 , 185 ].…”