Very early cardiac magnetic resonance imaging for quantification of myocardial tissue perfusion in patients receiving tirofiban before percutaneous coronary intervention for ST-elevation myocardial infarction

Steen, Henning; Lehrke, Stephanie; Wiegand, Uwe K.H.; Merten, Constanze; Schuster, L.; Richardt, Gert; Kulke, Christian; Gehl, H; Lima, João A.C.; Katus, Hugo A.; Giannitsis, Evangelos

doi:10.1016/j.ahj.2004.06.023

Cited by 33 publications

(15 citation statements)

References 25 publications

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“…The mean signal intensity before injection of the contrast agent was subtracted from all postcontrast data, and the upslope of the resulting time-intensity curves was calculated. 17 The maximal upslope in each segment was normalised by the maximal upslope in a remote segment (without delayed hyperenhancement and uniform wash-in over all slices), resulting in a normalised maximal upslope between 0 and 1 (fig 2). A cut-off value of ,0.6 for abnormal perfusion was based on receiver-operating characteristic analysis of its ability to predict segmental recovery.…”

Section: Cardiac Catheterisationmentioning

confidence: 99%

Microvascular perfusion 1 week and 6 months after myocardial infarction by first-pass perfusion cardiovascular magnetic resonance imaging

Bodı́

Sanchís

López‐Lereu

et al. 2006

Heart

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Objective: To characterise the evolution of myocardial perfusion during the first 6 months after myocardial infarction by first-pass perfusion cardiovascular magnetic resonance imaging (CMR) and determine its significance. Design: Prospective cohort design. Setting: Single-centre study in a teaching hospital in Spain. Patients: 40 patients with a first ST-elevation myocardial infarction, single-vessel disease and thrombolysis in myocardial infarction (TIMI) grade 3 flow (stent in 33 patients) underwent rest and low-dose dobutamine CMR 7 (SD 1) and 184 (SD 11) days after infarction. Microvascular perfusion was assessed at rest by visual assessment and quantitative analysis of first-pass perfusion CMR. Of the 640 segments, 290 segments subtended by the infarct-related artery (IRA) were focused on. Results: Both 1 week and 6 months after infarction, segments with normal perfusion showed more wall thickening, contractile reserve and wall thickness, and less transmural necrosis, p ,0.05 in all cases. Of 76 hypoperfused segments at the first week, 47 (62%) normalised perfusion at the sixth month. However, 42 segments (14% of the whole group) showed chronic abnormal perfusion; these segments showed worse CMR indices in the late phase (p,0.05 in all cases). Conclusions: In patients with an open IRA, more than half of the segments with abnormal perfusion at the first week are normally perfused after six months. First-pass perfusion CMR shows that in a small percentage of segments, abnormal perfusion may become a chronic phenomenon-these areas have a more severe deterioration of systolic function, wall thickness, contractile reserve and the transmural extent of necrosis.

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Section: Cardiac Catheterisationmentioning

confidence: 99%

Microvascular perfusion 1 week and 6 months after myocardial infarction by first-pass perfusion cardiovascular magnetic resonance imaging

Bodı́

Sanchís

López‐Lereu

et al. 2006

Heart

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“…This "no-reflow" phenomenon indicates lack of adequate tissue perfusion within the infarcted myocardium, even after restoration of epicardial blood flow [17]. The rapid advances in and refinement of imaging technologies over the past decade in particular have enabled investigators to detect and quantify regions of microvascular obstruction [18][19][20][21][22]. An important result gleaned from noninvasive imaging is the determination that microvascular obstruction (MO), as defined by a variety of diagnostic methods, carries prognostic significance [8,10,14,15,[22][23][24].…”

Section: Introductionmentioning

confidence: 99%

Imaging microvascular obstruction and its clinical significance following acute myocardial infarction

Luo

2006

Heart Fail Rev

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Obstruction of the coronary microvasculature contributes to the pathophysiology of MI and adversely affects post-MI recovery. This "no-reflow" phenomenon resulting from microvascular obstruction is an indicator of lack of adequate tissue perfusion within the infarcted myocardium, even after restoration of epicardial blood flow. Regions of microvascular obstruction can be detected and quantifed because of rapid advances in and refinement of imaging technologies over the past decade. This article focuses on the non-invasive imaging modalities used to assess MO, discusses the prognostic implications of MO, and briefly addresses strategies for reducing MO.

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“…In that study, infarct size and transmurality were not measured. 21 To the best of our knowledge, this is the first study to evaluate the efficacy of adjunctive treatment with tirofiban on infarct size and transmurality by CE-MRI.…”

Section: Infarct Size Measurement By Ce-mrimentioning

confidence: 93%

Upstream High‐Dose Tirofiban Does Not Reduce Myocardial Infarct Size in Patients Undergoing Primary Percutaneous Coronary Intervention: A Magnetic Resonance Imaging Pilot Study

Song

Hahn

Gwon

et al. 2009

Clinical Cardiology

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Background: Primary percutaneous coronary intervention (PCI) is more effective than fibrinolytic therapy for ST-segment elevation myocardial infarction (STEMI), but initial treatment delay to intervention is the main limitation of this strategy. Hypothesis: Upstream use of high-dose tirofiban could reduce myocardial infarct size, using analysis of contrast-enhanced magnetic resonance imaging (CE-MRI). Methods: Patients with STEMI within 12 hours after symptom onset were randomized to a facilitated PCI group (n = 19) or to a primary PCI group (n = 20). The primary endpoint was myocardial infarct size evaluated by the volume of delayed hyperenhancement on CE-MRI at 1 month after index procedure. Results: The baseline clinical characteristics were not significantly different between the 2 groups. Although the incidence of pre-PCI thrombolysis in myocardial infarction (TIMI) flow grade 2 to 3 was significantly higher in the facilitated PCI group than in the primary PCI group (47.4% vs 15.0%, P = 0.03), the achievement of myocardial blush grade 2 to 3 or ST-segment resolution at 30 minutes after procedure was not significantly different between the facilitated PCI and the primary PCI group (36.8% vs 40%, P = .84 and 31.6% vs 20%, P = 0.41, respectively). Infarct size on CE-MRI was similar in the facilitated PCI group and the conventional primary PCI group (22.1% ± 11.7% vs 25.2% ± 13.2%, P = 0.44). At 6 months, the left ventricular ejection fraction (LVEF) on echocardiography was 52.6% ± 10.4% in the facilitated PCI group and 50.9% ± 9.8% in the primary PCI group (P = 0.68). Conclusion: Despite the improvement of initial TIMI flow grade, the upstream use of high-dose tirofiban did not reduce myocardial infarct size measured by CE-MRI.

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Very early cardiac magnetic resonance imaging for quantification of myocardial tissue perfusion in patients receiving tirofiban before percutaneous coronary intervention for ST-elevation myocardial infarction

Cited by 33 publications

References 25 publications

Microvascular perfusion 1 week and 6 months after myocardial infarction by first-pass perfusion cardiovascular magnetic resonance imaging

Microvascular perfusion 1 week and 6 months after myocardial infarction by first-pass perfusion cardiovascular magnetic resonance imaging

Imaging microvascular obstruction and its clinical significance following acute myocardial infarction

Upstream High‐Dose Tirofiban Does Not Reduce Myocardial Infarct Size in Patients Undergoing Primary Percutaneous Coronary Intervention: A Magnetic Resonance Imaging Pilot Study

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