title: Functional recovery after acute myocardial infarction: comparison between angiography, electrocardiography, and cardiovascular magnetic resonance measures of microvascular injury.
abstract: OBJECTIVE
  We examined the relation between angiographic, electrocardiographic, and gadolinium-enhanced cardiovascular magnetic resonance (CMR) characteristics of microvascular obstruction (MVO), and their predictive value on functional recovery after acute myocardial infarction (AMI).
  
  
  BACKGROUND
  Microvascular obstruction on CMR has been shown to predict left ventricular (LV) remodeling, but it is not well known how it compares with commonly used criteria of microvascular injury, and earlier reports have produced conflicting results on the significance and extent of MVO.
  
  
  METHODS
  Thrombolysis In Myocardial Infarction (TIMI) flow grade, myocardial blush grade (MBG), and ST-segment resolution were assessed in 60 patients with AMI treated with primary stenting. Cardiovascular magnetic resonance was performed between 2 and 9 days after revascularization to determine early MVO on first-pass perfusion imaging, late MVO on late gadolinium-enhanced imaging, and infarct size and transmural extent. Cine imaging was used to determine LV volumes and global and regional function at baseline and 4-month follow-up.
  
  
  RESULTS
  Early and late MVO were both related to incomplete ST-segment resolution (p = 0.002 and p = 0.01, respectively), but not to TIMI flow grade and MBG. Of all angiographic, electrocardiographic, and CMR variables, late MVO was the strongest parameter to predict changes in end-diastolic volume (beta = 0.53; p = 0.001), end-systolic volume (beta = 8.67; p = 0.001), and ejection fraction (beta = 3.94; p = 0.006) at follow-up. Regional analysis showed that late MVO had incremental diagnostic value to transmural extent of infarction (odds ratio: 0.18; p < 0.0001).
  
  
  CONCLUSIONS
  In patients after revascularized AMI, late MVO proved a more powerful predictor of global and regional functional recovery than all of the other characteristics, including transmural extent of infarction.
authors.affiliation: Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands. r.nijveldt@vumc.nl
authors.forename: Robin
authors.initials: R
authors.lastname: Nijveldt
authors.forename: Aernout M
authors.initials: AM
authors.lastname: Beek
authors.forename: Alexander
authors.initials: A
authors.lastname: Hirsch
authors.forename: Martin G
authors.initials: MG
authors.lastname: Stoel
authors.forename: Mark B M
authors.initials: MB
authors.lastname: Hofman
authors.forename: Victor A W M
authors.initials: VA
authors.lastname: Umans
authors.forename: Paul R
authors.initials: PR
authors.lastname: Algra
authors.forename: Jos W R
authors.initials: JW
authors.lastname: Twisk
authors.forename: Albert C
authors.initials: AC
authors.lastname: van Rossum
mesh_terms: D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D005682:Gadolinium; D006329:Heart Conduction System / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000209:etiology; D008279:Magnetic Resonance Imaging / Q000295:instrumentation / Q000379:methods; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D013318:Stroke Volume
chemical_list: D005682:Gadolinium