Anna Damascelli MD, Presenter: Nothing to Disclose

Francesco Aldo De Cobelli MD, Abstract Co-Author: Nothing to Disclose

Antonio Esposito MD, Abstract Co-Author: Nothing to Disclose

Giulia Benedetti, Abstract Co-Author: Nothing to Disclose

Paolo Guido Camici, Abstract Co-Author: Nothing to Disclose

Alessandro Del Maschio MD, Abstract Co-Author: Nothing to Disclose

Cardiac magnetic resonance (CMR) has been recognized as the gold standard technique for in vivo evaluation of myocardial damage in patients with ST-elevation myocardial infarction (STEMI), but its role in prognostic stratification is still under investigation. Great attention has recently been directed on microvascular obstruction (MVO). The aim of this study is to evaluate how MVO impacts on left ventricle remodeling.

This is an ongoing prospective study in which 58 consecutive STEMI patients, admitted to our ER, were enrolled. Patients were treated with PCI and underwent a first CMR study (1.5 T magnet) within 5 days from the infarction. A subgroup underwent a second CMR as well, after 6 months. The main morpho-functional CMR parameters were assessed on both CMR study. Left ventricle end-diastolic and end-systolic volume variation between the second and the first CMR (∆EDV and ∆ESV) were used as parameters of left ventricle remodeling. The criteria for MVO were a sub-endocardial lack of enhancement on first-pass perfusion and the presence of a hypointense region, within the area of infarction, on late gadolinium enhancement (LGE) sequences.

A group of 16 patients (age 59±8 yrs; 15 male and 1 female) underwent both CMR studies. Patients with MVO showed a significant increase in EDV and ESV compared to patients without MVO (∆EDV=34±32ml, p=0.004 vs ∆EDV=4.5±16ml, p=0.6 and ∆ESV=15±19 ml, p=0.018 vs ∆ESV=1±15ml, p=0.9). At regression analysis MVO, LGE and perfusion defect significantly correlated with ∆EDV (MVO%: p<0.001; R-square=0.72; LGE%: p=0.006, R-square=0.42; perfusion defect%: p=0.001; R-square=0.55) and ∆ESV (MVO%: p<0.001; R-square=0.64; LE%: p=0.03, R-square=0.3; perfusion defect%: p=0.005; R-square=0.44). Otherwise at multivariate analysis only MVO% presented a significant relation with ∆EDV (p=0.035) and ∆ESV (p=0.039). 

These preliminary data suggest that MVO is involved in left ventricle remodeling after myocardial infarction with a stronger effect on left ventricle enlargement than LE.

MVO detected by CMR after STEMI predicts left ventricle remodeling: the larger MVO area the greater LV dilation after the infarction.

Damascelli, A, De Cobelli, F, Esposito, A, Benedetti, G, Camici, P, Del Maschio, A, Cardiac Magnetic Resonance Predicts Left Ventricle Remodeling after Myocardial Infarction: The Role of Microvascular Obstruction.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14013498.html