Marco Francone MD, Presenter: Nothing to Disclose

Matteo Mangia, Abstract Co-Author: Nothing to Disclose

Paola Lucchesi, Abstract Co-Author: Nothing to Disclose

Federica Vasselli, Abstract Co-Author: Nothing to Disclose

Carlo Catalano MD, Abstract Co-Author: Nothing to Disclose

Roberto Passariello MD, Abstract Co-Author: Nothing to Disclose

R-PTCA is recommended in patients (pts) with acute myocardial infarction (AMI) after an unsuccessful thrombolysis. The procedure is associated with high risk of hemorrhagic complications including IMH reflecting severe microvascular injury caused by extravasation of erythrocytes into reperfused myocardium. Cardiac MR (CMR) represents the method of choice to detect its presence in vivo showing paramagnetic susceptibility effect of deoxyhemoglobin on T2w images. The present study was designed to evaluate incidence,CMR features and functional behaviour of IMH comparing 2 groups of pts treated with primary PTCA vs R-PTCA.

56 pts with AMI underwent coronary reperfusion with primary PTCA(n=40) or R-PTCA(n=16). In all cases a CMR protocol including TSE T2w black-blood, 1st-pass and delayed enhancement(DE) sequences was performed within one week after the acute event and after 3 months; T2w STAR images were also available in 16 pts. IMH was identified according to T2w signal and differentiated from myocardial edema (ME). Left ventricular ejection fraction (LVEF) and myocardial wall thickness (MWT) were also quantified.

12 pts(21%) showed IMH as a central hypointense core with peripheral hyperintense rim on T2w CMR imaging and 44(79%) pts showed homogeneous hyperintense signal consistent with ME; IMH was observed in 7/16(43%) R-PTCA pts and 5/40(12%) primary PTCA. Among R-PTCA group, infarct size and MWT were larger in pts with HMI (33±11%vs.19±15% p=0.097 and 9.1±3.5mmvs6.9±1.9mm p<0.05 respectively) . Perfusion defects were observed in 12/12(100%) cases with IMH and in 11/44(25%) with ME. At follow-up, LVEF showed less recovery in patients with HMI (43±11to46±10%; p = 0.47 vs.46±3to50±10% p < 0.05).

IMH occurs more frequently in R-PTCA group as a result of previous thrombolysis. Although further studies with long terms follow-up will be necessary to understand its real clinical significance IMH may represent a new negative predictor for LV functional recovery.

IMH occurs in 43% of R-PTCA treated pts after AMI and reflects severe microvascular injury with potential negative LV functional recovery.

Francone, M, Mangia, M, Lucchesi, P, Vasselli, F, Catalano, C, Passariello, R, Cardiac MR (CMR) Detection of Intramyocardial Haemorrhage(IMH) Following Coronary ReperfusionCcomparison between Primary Percutaneous Transluminal Coronary Angioplasty (PTCA) and Rescue PTCA (R-PTCA).  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5013290.html