Department of Cardiology, VU University Medical Center, De Boelelaan 1117, Amsterdam, The Netherlands.
Int J Cardiovasc Imaging. 2010 Jan;26(1):49-55. doi: 10.1007/s10554-009-9499-1. Epub 2009 Sep 15.
Reperfusion may cause intramyocardial hemorrhage (IMH) by extravasation of erythrocytes through severely damaged endothelial walls. The purpose of the study was to evaluate the clinical significance of IMH in relation to infarct size, microvascular obstruction (MVO) and function in patients after primary percutaneous intervention. Forty-five patients underwent cardiovascular MR imaging (CMR) 1 week and 4 months after primary stenting for a first acute myocardial infarction. T2-weighted spin-echo imaging (T2W) was used to assess infarct related edema and IMH, and delayed enhancement (DE) was used to assess infarct size and MVO. Cine CMR was used to assess left ventricular volumes and function at baseline and at 4 months follow-up. In 22 (49%) patients, IMH was detected as areas of attenuated signal in the core of the high signal intensity region on T2W images. Patients with IMH had larger infarcts, higher left ventricular volumes and lower ejection fraction. Contrast-to-noise ratio (CNR) between hyperintense periphery and the hypo-intense core of the T2W ischemic area correlated to peak CKMB, total infarct size and MVO size. Using univariable analysis, CNR predicted ejection fraction at baseline (beta = -0.62, P = 0.003) and follow-up (beta = -0.84, P < 0.001). However, after multivariable analysis, baseline ejection fraction and presence of MVO were the only parameters that predicted functional changes at follow-up. IMH was found in the majority of patients with MVO after reperfused myocardial infarction. It was closely related to markers of infarct size, MVO and function, but did not have prognostic significance beyond MVO.
再灌注可能会导致红细胞通过严重受损的内皮壁渗出，从而引起心肌内出血（IMH）。本研究的目的是评估 IMH 与梗塞面积、微血管阻塞（MVO）和功能之间的临床意义，研究对象为接受直接经皮冠状动脉介入治疗的首发急性心肌梗死患者。45 例患者在首次急性心肌梗死后 1 周和 4 个月时接受心血管磁共振成像（CMR）检查。T2 加权自旋回波成像（T2W）用于评估与梗塞相关的水肿和 IMH，延迟增强（DE）用于评估梗塞面积和 MVO。电影 CMR 用于在基线和 4 个月随访时评估左心室容积和功能。在 22 例（49%）患者中，T2W 图像上高信号强度区域的核心部位出现信号衰减区，从而检测到 IMH。有 IMH 的患者梗塞面积较大，左心室容积较大，射血分数较低。高信号强度区域的外周与 T2W 缺血区域的低信号强度核心之间的对比噪声比（CNR）与 CKMB 峰值、总梗塞面积和 MVO 大小相关。在单变量分析中，CNR 可预测基线时的射血分数（β = -0.62，P = 0.003）和随访时的射血分数（β = -0.84，P < 0.001）。然而，在多变量分析中，基线射血分数和 MVO 的存在是预测随访时功能变化的唯一参数。再灌注性心肌梗死后的大多数患者中都发现了 MVO 伴 IMH。它与梗塞面积、MVO 和功能的标志物密切相关，但除了 MVO 之外，它并没有预后意义。
