Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands.
Eur Heart J. 2013 Aug;34(30):2346-53. doi: 10.1093/eurheartj/eht100. Epub 2013 Apr 17.
Lack of gadolinium-contrast wash-in on first-pass perfusion imaging, early gadolinium-enhanced imaging, or late gadolinium-enhanced (LGE) cardiovascular magnetic resonance (CMR) imaging after revascularized ST-elevation myocardial infarction (STEMI) is commonly referred to as microvascular obstruction (MVO). Additionally, T2-weighted imaging allows for the visualization of infarct-related oedema and intramyocardial haemorrhage (IMH) within the infarction. However, the exact histopathological correlate of the contrast-devoid core and its relation to IMH is unknown.
In eight Yorkshire swine, the circumflex coronary artery was occluded for 75 min by a balloon catheter. After 7 days, CMR with cine imaging, T2-weighted turbospinecho, and LGE was performed. Cardiovascular magnetic resonance images were compared with histological findings after phosphotungstic acid-haematoxylin and anti-CD31/haematoxylin staining. These findings were compared with CMR findings in 27 consecutive PCI-treated STEMI patients, using the same scanning protocol. In the porcine model, the infarct core contained extensive necrosis and erythrocyte extravasation, without intact vasculature and hence, no MVO. The surrounding-gadolinium-enhanced-area contained granulation tissue, leucocyte infiltration, and necrosis with morphological intact microvessels containing microthrombi, without erythrocyte extravasation. Areas with IMH (median size 1.92 [0.36-5.25] cm(3)) and MVO (median size 2.19 [0.40-4.58] cm(3)) showed close anatomic correlation [intraclass correlation coefficient (ICC) 0.85, r = 0.85, P = 0.03]. Of the 27 STEMI patients, 15 had IMH (median size 6.60 [2.49-9.79] cm(3)) and 16 had MVO (median size 4.31 [1.05-7.57] cm(3)). Again, IMH and MVO showed close anatomic correlation (ICC 0.87, r = 0.93, P < 0.001).
The contrast-devoid core of revascularized STEMI contains extensive erythrocyte extravasation with microvascular damage. Attenuating the reperfusion-induced haemorrhage may be a novel target in future adjunctive STEMI treatment.
经再血管化治疗的 ST 段抬高型心肌梗死（STEMI）患者，其首过灌注成像、早期钆增强成像或晚期钆增强（LGE）心血管磁共振（CMR）成像上未见对比剂填充，通常被称为微血管阻塞（MVO）。此外，T2 加权成像可显示梗死相关水肿和心肌内出血（IMH）。然而，对比剂缺乏核心的确切组织病理学相关及其与 IMH 的关系尚不清楚。
在 8 头约克夏猪中，通过球囊导管将回旋支冠状动脉闭塞 75 分钟。7 天后，进行电影成像、T2 加权涡轮自旋回波和 LGE 的 CMR。心血管磁共振图像与磷钨酸-苏木精和抗 CD31/苏木精染色后的组织学发现进行比较。使用相同的扫描方案，将这些发现与 27 例连续接受经皮冠状动脉介入治疗（PCI）的 STEMI 患者的 CMR 结果进行比较。在猪模型中，梗死核心包含广泛的坏死和红细胞外渗，但没有完整的血管，因此没有 MVO。周围增强区域包含肉芽组织、白细胞浸润和坏死，形态完整的微血管内有微血栓，没有红细胞外渗。含有 IMH（中位数大小 1.92 [0.36-5.25] cm3）和 MVO（中位数大小 2.19 [0.40-4.58] cm3）的区域具有紧密的解剖相关性[组内相关系数（ICC）0.85，r = 0.85，P = 0.03]。在 27 例 STEMI 患者中，15 例有 IMH（中位数大小 6.60 [2.49-9.79] cm3），16 例有 MVO（中位数大小 4.31 [1.05-7.57] cm3）。同样，IMH 和 MVO 具有紧密的解剖相关性（ICC 0.87，r = 0.93，P < 0.001）。
再血管化治疗的 STEMI 患者的对比剂缺乏核心区域含有广泛的红细胞外渗和微血管损伤。减轻再灌注诱导的出血可能是未来 STEMI 治疗的新靶点。
