PMID- 20965977
OWN - NLM
STAT- MEDLINE
DCOM- 20110516
LR  - 20161203
IS  - 1468-201X (Electronic)
IS  - 1355-6037 (Linking)
VI  - 96
IP  - 23
DP  - 2010 Dec
TI  - Assessment of severe reperfusion injury with T2* cardiac MRI in patients with 
      acute myocardial infarction.
PG  - 1885-91
LID - 10.1136/hrt.2010.200634 [doi]
AB  - BACKGROUND: In patients with acute myocardial infarction, restoration of coronary 
      flow by primary coronary intervention (PCI) can lead to profound 
      ischaemia-reperfusion injury with detrimental effects on myocardial salvage. 
      Non-invasive assessment of interstitial myocardial haemorrhage by T2* cardiac MRI 
      (T2*-CMR) provides a novel and specific biomarker of severe reperfusion injury 
      which may be of prognostic value. OBJECTIVE: To characterise the determinants of 
      acute ischaemia-reperfusion injury following ST elevation myocardial infarction 
      (STEMI) using CMR. METHODS AND RESULTS: Fifty patients with acute STEMI who had 
      been successfully treated by PCI were studied. T2*-CMR was used to identify the 
      presence of reperfusion haemorrhage and contrast enhancement was used to measure 
      microvascular obstruction (MVO) and infarct size. Haemorrhagic 
      ischaemia-reperfusion injury was present in 29 patients (58%) following PCI and 
      occurred despite rapid revascularisation (mean 4.2+/-3.3 h). Haemorrhage was only 
      present when the infarct involved at least 80% (mean+/-SD 91+/-5.3%) of the left 
      ventricular wall thickness. There was a strong association between the extent of 
      MVO and reperfusion haemorrhage (r(2)=0.87, p<0.001). Transmural infarcts (n=43) 
      showed significantly impaired systolic wall thickening at the infarct mid point 
      when reperfusion haemorrhage was present (21.5+/-16.7% vs 3.7+/-12.9%), p<0.0001) 
      compared with non-haemorrhagic infarcts. CONCLUSIONS: Severe reperfusion injury 
      may occur when there is near-transmural myocardial necrosis despite early and 
      successful revascularisation. Reperfusion haemorrhage is closely associated with 
      the development of MVO. These findings indicate that, once advanced necrosis has 
      developed, the potential for severe myocardial reperfusion injury is 
      significantly enhanced.
FAU - O'Regan, Declan P
AU  - O'Regan DP
AD  - MRC Clinical Sciences Centre, Robert Steiner MRI Unit, Faculty of Medicine, 
      Imperial College, Hammersmith Hospital Campus, Du Cane Road, London, UK. 
      declan.oregan@csc.mrc.ac.uk
FAU - Ariff, Ben
AU  - Ariff B
FAU - Neuwirth, Clare
AU  - Neuwirth C
FAU - Tan, Yvonne
AU  - Tan Y
FAU - Durighel, Giuliana
AU  - Durighel G
FAU - Cook, Stuart A
AU  - Cook SA
LA  - eng
GR  - Medical Research Council/United Kingdom
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20101021
PL  - England
TA  - Heart
JT  - Heart (British Cardiac Society)
JID - 9602087
RN  - 0 (Anticoagulants)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged, 80 and over
MH  - Angioplasty, Balloon, Coronary/adverse effects
MH  - Anticoagulants/therapeutic use
MH  - Female
MH  - Hemorrhage/etiology
MH  - Humans
MH  - Magnetic Resonance Angiography
MH  - Male
MH  - Microcirculation/physiology
MH  - Middle Aged
MH  - Myocardial Infarction/*therapy
MH  - Myocardial Reperfusion/adverse effects
MH  - Myocardial Reperfusion Injury/*pathology
MH  - Young Adult
EDAT- 2010/10/23 06:00
MHDA- 2011/05/17 06:00
CRDT- 2010/10/23 06:00
PHST- 2010/10/23 06:00 [entrez]
PHST- 2010/10/23 06:00 [pubmed]
PHST- 2011/05/17 06:00 [medline]
AID - hrt.2010.200634 [pii]
AID - 10.1136/hrt.2010.200634 [doi]
PST - ppublish
SO  - Heart. 2010 Dec;96(23):1885-91. doi: 10.1136/hrt.2010.200634. Epub 2010 Oct 21.