Yuka Morita MD, Presenter: Nothing to Disclose

Takuya Ueda MD, Abstract Co-Author: Nothing to Disclose

Taku Asano MD, Abstract Co-Author: Nothing to Disclose

Yasuyuki Kurihara MD, Abstract Co-Author: Nothing to Disclose

Atsushi Mizuno, Abstract Co-Author: Nothing to Disclose

Microvascular obstruction (MVO) and intramyocardial hemorrhage (IMH) in infarction/re-perfusion injury adversely affect left ventricular remodeling and prognosis in patients with ST-elevated acute myocardial infarction (STEMI) who were treated with primary percutaneous coronary intervention (PCI). The purpose of this study is to evaluate the detectability of IMH using T2*WI on 3T-MR scanner and the relationship between IMH and clinical factors reflecting poor prognosis in patients with STEMI treated with PCI.

A total of 45 consecutive patients who were treated with PCI were prospectively enrolled in this study from October 2012 to January 2014. All patients underwent cardiac MR imaging with late gadolinium enhancement (LGE) and T2*WI within two weeks after primary percutaneous coronary intervention for AMI using 3T-MR scanner (Magnetom Verio, Siemens Medical Solutions, Germany). We assessed LGE and T2*WI for the presence of MVO and IMH, respectively. Clinical factors of patients (age, sex, coronary risk factors and culprit coronary artery) were compared between patients with/without MVO and with/without IMH. Symptom to balloon time (SBT) and peak creatine kinase (CK) values were also compared among three groups: MVO(-)/IMH(-), MVO(+)/IMH(-) and MVO(+)/IMH(+).

LGE and T2*WI demonstrated MVO in 32 out of 45 patiens (71%) and IMH in 21/45 (47%) patients, respectively. The peak CK values were significantly higher in patients with MVO (p<0.001) and with IMH (p<0.001) and showed linearly and positively correlated with them (r=0.65 and r=0.70, respectively). In comparison of three groups, there was no significant difference between MVO(-)/IMH(-) group and MVO(+)/IMH(-) groups. Whereas, MVO(+)/IMH(+) group had significantly higher peak CK values than MVO(-)/IMH(-) group (p<0.001) and MVO(+)/IMH(-) group (p=0.01). Presence of both MVO and IMH showed no correlation with the clinical factors of patients and SBT.

T2*WI on 3T-MR scanner significantly correlated with peak CK values. There was clear difference of peak CK values between MVO(+)/IMH(-) and MVO(+)/IMH(+) group. This study suggests that coexistence of IMH detected by T2*WI on 3T-MR scanner and MVO on LGE may be a significant indicator of poor prognosis in STEMI patients treated with PCI.

T2*WI at 3T-MR is a useful tool to predict prognosis of STEMI patients treated with PCI and may affect on patient care.

Morita, Y, Ueda, T, Asano, T, Kurihara, Y, Mizuno, A, Detection of Hemorrhagic Infarction/re-perfusion Injury in Patients with ST-elevated Acute Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention using 3T-T2*-weighted Magnetic Resonance Imaging.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045589.html