Late microvascular obstruction after acute myocardial infarction: relation with cardiac and inflammatory markers.
OBJECTIVE
We sought to assess the relation of late microvascular obstruction (l-MVO) size as quantified by cardiac magnetic resonance (CMR) imaging with cardiac and inflammatory marker concentrations after acute myocardial infarction (AMI).


METHODS
CMR was performed in 118 consecutive patients within 8 days after successful interventional reperfused first acute ST-elevation AMI. Infarct volumes and l-MVO sizes were calculated from late enhancement (LE) sequences and functional parameters were determined from short-axis cine MR sequences. Creatine kinase (CK) and cardiac troponin T (cTnT), high-sensitivity C-reactive protein (hs-CRP) as well as lactate dehydrogenase (LD) concentrations were determined serially from day 1 to day 4 after symptom onset.


RESULTS
L-MVO was detected in 66/118 patients (55.9%) and comprised 18.2 ± 10% of infarct size and 4.7 ± 3% of left ventricle myocardial mass. Each single-point, peak and cumulative release concentration of cTnT (r=0.44 to 0.73, p<0.0001), CK (r=0.21 to 0.76, p<0.0001), LD (r=0.36 to 0.82, all p<0.0001) as well as hs-CRP single-point values as assessed from day 1 to day 4 and its peak and cumulative release concentrations (r=0.24 to 0.49, p<0.003) significantly correlated with l-MVO size. Receiver operating curve (ROC) analysis indicated a cut-off value of 4.7 μg/l cTnT to best identify the presence of l-MVO (area under the curve (AUC) 0.904; 95% CI: 0.85-0.95; p<0.0001).


CONCLUSIONS
L-MVO sizes significantly correlate with cardiac and inflammatory marker concentrations as determined early after AMI. cTnT concentration of >4.7 μg/l could help to identify patients in whom l-MVO is present.
University Hospital of Internal Medicine III/Cardiology, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria.
Agnes
A
Mayr
Gert
G
Klug
Michael
M
Schocke
Thomas
T
Trieb
Johannes
J
Mair
Kathrin
K
Pedarnig
Otmar
O
Pachinger
Werner
W
Jaschke
Bernhard
B
Metzler
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000378:metabolism; D002097:C-Reactive Protein / Q000502:physiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000502:physiology*; D008297:Male; D055806:Microvessels / Q000378:metabolism / Q000473:pathology* / Q000503:physiopathology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000473:pathology* / Q000503:physiopathology*; D013997:Time Factors; D020107:Troponin T / Q000502:physiology
D015415:Biomarkers; D018836:Inflammation Mediators; D020107:Troponin T; D002097:C-Reactive Protein