Relationship and prognostic value of microvascular obstruction and infarct size in ST-elevation myocardial infarction as visualized by magnetic resonance imaging

Waha, Suzanne de; Desch, Steffen; Eitel, Ingo; Fuernau, Georg; Lurz, Philipp; Leuschner, Anja; Gutberlet, Matthias; Schuler, Gerhard; Thiele, Holger

doi:10.1007/s00392-012-0419-3

Cited by 56 publications

(25 citation statements)

References 42 publications

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“…In a study by de Waha et al (63) in 438 patients, the extents of EMVO (hazard ratio: 1.03; 95% CI: 1.02 to 1.05) and EMVO/IS (hazard ratio: 2.22; 95% CI: 1.60 to 3.08) were identified as independent predictors of MACE (62). Bruder et al (64) identified a cutoff EMVO value of >0.5 (% of LV mass) to predict MACE (odds ratio: 3.9; 95% CI: 1.1 to 13.9).…”

Section: Resultsmentioning

confidence: 99%

Effect of Microvascular Obstruction and Intramyocardial Hemorrhage by CMR on LV Remodeling and Outcomes After Myocardial Infarction

Hamirani

Wong

Kramer

et al. 2014

JACC: Cardiovascular Imaging

222

138

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The goal of this systematic analysis is to provide a comprehensive review of the current cardiac magnetic resonance data on microvascular obstruction (MVO) and intramyocardial hemorrhage (IMH). Data related to the association of MVO and IMH in patients with acute myocardial infarction (MI) with left ventricular (LV) function, volumes, adverse LV remodeling, and major adverse cardiac events (MACE) were critically analyzed. MVO is associated with a lower ejection fraction, increased ventricular volumes and infarct size, and a greater risk of MACE. Late MVO is shown to be a stronger prognostic marker for MACE and cardiac death, recurrent MI, congestive heart failure/heart failure hospitalization, and follow-up LV end-systolic volumes than early MVO. IMH is associated with LV remodeling and MACE on pooled analysis, but because of limited data and heterogeneity in study methodology, the effects of IMH on remodeling require further investigation.

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Section: Resultsmentioning

confidence: 99%

Effect of Microvascular Obstruction and Intramyocardial Hemorrhage by CMR on LV Remodeling and Outcomes After Myocardial Infarction

Hamirani

Wong

Kramer

et al. 2014

JACC: Cardiovascular Imaging

222

138

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“…LGE-derived MVO (‘late MVO’) is felt to be the most important measure of MVO because of its strong correlation with ST-segment resolution, adverse ventricular remodeling [5] and major adverse cardiovascular events [9,26]. In both experimental models [27] and in patients treated by PPCI there is a strong correlation between MVO extent and IS on CMR [28,29].…”

Section: Discussionmentioning

confidence: 99%

Prevalence and extent of infarct and microvascular obstruction following different reperfusion therapies in ST-elevation myocardial infarction

Khan

Razvi

Nazir

et al. 2014

Journal of Cardiovascular Magnetic Resonance

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BackgroundMicrovascular obstruction (MVO) describes suboptimal tissue perfusion despite restoration of infarct-related artery flow. There are scarce data on Infarct Size (IS) and MVO in relation to the mode and timing of reperfusion. We sought to characterise the prevalence and extent of microvascular injury and IS using Cardiovascular magnetic resonance (CMR), in relation to the mode of reperfusion following acute ST-Elevation Myocardial Infarction (STEMI).MethodsCMR infarct characteristics were measured in 94 STEMI patients (age 61.0 ± 13.1 years) at 1.5 T. Seventy-three received reperfusion therapy: primary percutaneous coronary-intervention (PPCI, n = 47); thrombolysis (n = 12); rescue PCI (R-PCI, n = 8), late PCI (n = 6). Twenty-one patients presented late (>12 hours) and did not receive reperfusion therapy.ResultsIS was smaller in PPCI (19.8 ± 13.2% of LV mass) and thrombolysis (15.2 ± 10.1%) groups compared to patients in the late PCI (40.0 ± 15.6%) and R-PCI (34.2 ± 18.9%) groups, p <0.001. The prevalence of MVO was similar across all groups and was seen at least as frequently in the non-reperfused group (15/21, [76%] v 33/59, [56%], p = 0.21) and to a similar magnitude (1.3 (0.0-2.8) v 0.4 [0.0-2.9]% LV mass, p = 0.36) compared to patients receiving early reperfusion therapy. In the 73 reperfused patients, time to reperfusion, ischaemia area at risk and TIMI grade post-PCI were the strongest independent predictors of IS and MVO.ConclusionsIn patients with acute STEMI, CMR-measured MVO is not exclusive to reperfusion therapy and is primarily related to ischaemic time. This finding has important implications for clinical trials that use CMR to assess the efficacy of therapies to reduce reperfusion injury in STEMI.

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“…In another study, MVO was an independent predictor of major adverse cardiac events (MACE) and cardiac death, whereas infarct size was not 50. De Waha et al 51 showed that the ratio of MVO/infarct size is a more powerful predictor for long-term outcome than either parameter alone.…”

Section: D) Cmr In Clinical Decision-making—acute Coronary Syndromesmentioning

confidence: 99%

MRI in the assessment of ischaemic heart disease

Rodrigues

Baritussio

Bucciarelli-Ducci

2015

Heart

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Relationship and prognostic value of microvascular obstruction and infarct size in ST-elevation myocardial infarction as visualized by magnetic resonance imaging

Cited by 56 publications

References 42 publications

Effect of Microvascular Obstruction and Intramyocardial Hemorrhage by CMR on LV Remodeling and Outcomes After Myocardial Infarction

Effect of Microvascular Obstruction and Intramyocardial Hemorrhage by CMR on LV Remodeling and Outcomes After Myocardial Infarction

Prevalence and extent of infarct and microvascular obstruction following different reperfusion therapies in ST-elevation myocardial infarction

MRI in the assessment of ischaemic heart disease

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