Late gadolinium-enhanced cardiovascular magnetic resonance evaluation of infarct size and microvascular obstruction in optimally treated patients after acute myocardial infarction.
OBJECTIVE
Cardiovascular magnetic resonance (CMR) is considered the standard imaging modality in clinical trials to monitor patients after acute myocardial infarction (AMI). However, limited data is available with respect to infarct size, presence, and extent of microvascular injury (MVO), and changes over time, in relation to cardiac function in these optimally treated patients. In this study, we prospectively investigate the change of infarct size over time, and the incidence and significance of MVO in a uniform, optimally treated patient group after AMI.


METHODS
Forty patients underwent cine and late gadolinium-enhanced CMR within 9 days and at 4 months after primary stenting. Left ventricular ejection fraction (LVEF), infarct size (IS) and MVO size were calculated.


RESULTS
IS decreased with 19.0% at follow-up (p<0.01). The 23 (57.5%) patients with MVO had larger infarct size, higher left ventricular volumes and lower LVEF and more involution of IS at follow-up. Overall, LVEF improved from 42.3+/-9.8% to 44.0+/-9.8% (p=0.06), irrespective of presence or size of MVO.


CONCLUSIONS
Infarct size reduces over time by 19.0% in optimally treated patients after AMI. Despite optimal reperfusion, MVO was found in the majority of patients. Although patients with MVO had larger infarcts and worse indices of left ventricular remodelling, functional change at follow-up was comparable to patients without MVO.
Nijveldt
Robin
R
Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands. R.Nijveldt@vumc.nl
Beek
Aernout M
AM
Hofman
Mark B M
MB
Umans
Victor A W M
VA
Algra
Paul R
PR
Spreeuwenberg
Marieke D
MD
Visser
Cees A
CA
van Rossum
Albert C
AC
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D003287:Contrast Media; D003326:Coronary Circulation; D005260:Female; D005500:Follow-Up Studies; D019786:Gadolinium DTPA; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008833:Microcirculation / Q000473:pathology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D011446:Prospective Studies; D012107:Research Design; D015607:Stents; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
D002317:Cardiovascular Agents; D003287:Contrast Media; D019786:Gadolinium DTPA