title: Prognostic value and determinants of a hypointense infarct core in T2-weighted cardiac magnetic resonance in acute reperfused ST-elevation-myocardial infarction.
abstract: BACKGROUND
  A hypointense core of infarcted myocardium in T2-weighted cardiovascular MRI (CMR) has been used as a noninvasive marker for intramyocardial hemorrhage. However, the clinical significance of such findings not yet been established. The aim of this study was to evaluate determinants and prognostic impact of a hypointense infarct core in T2-weighted CMR images, studied in patients after acute, reperfused ST-elevation-myocardial infarction.
  
  
  RESULTS
  We analyzed 346 patients with ST-elevation-myocardial infarction undergoing primary angioplasty < 12 hours after symptoms onset. T2-weighted, contrast-enhanced CMR was used for assessment of the area at risk, myocardial salvage, infarct size, hypointense core in T2-weighted images, and late microvascular obstruction. Patients were categorized into 2 groups defined by the presence or absence of a hypointense core. The primary end point of the study was occurrence of major adverse cardiovascular events defined as death, reinfarction, and congestive heart failure within 6 months after infarction. A hypointense core was present in 122 (35%) patients and was associated with larger infarcts, greater amount of microvascular obstruction, less myocardial salvage, and impaired left ventricular function (P < 0.001, respectively). The presence of a hypointense core was a strong univariable predictor of major adverse cardiovascular events (hazard ratio, 2.59; confidence interval, 1.27 to 5.27) and was significantly associated with an increased major adverse cardiovascular events rate (16.4% versus 7.0%, P = 0.006) 6 months after infarction.
  
  
  CONCLUSIONS
  A hypointense infarct core within the area at risk of reperfused infarcted myocardium in T2-weighted CMR is closely related to infarct size, microvascular obstruction, and impaired left ventricular function, with subsequent adverse clinical outcome.
authors.affiliation: University of Leipzig-Heart Center, Department of Internal Medicine-Cardiology, Leipzig, Germany. ingoeitel@gmx.de
authors.forename: Ingo
authors.initials: I
authors.lastname: Eitel
authors.forename: Konrad
authors.initials: K
authors.lastname: Kubusch
authors.forename: Oliver
authors.initials: O
authors.lastname: Strohm
authors.forename: Steffen
authors.initials: S
authors.lastname: Desch
authors.forename: Yoko
authors.initials: Y
authors.lastname: Mikami
authors.forename: Suzanne
authors.initials: S
authors.lastname: de Waha
authors.forename: Matthias
authors.initials: M
authors.lastname: Gutberlet
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuler
authors.forename: Matthias G
authors.initials: MG
authors.lastname: Friedrich
authors.forename: Holger
authors.initials: H
authors.lastname: Thiele
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D016009:Chi-Square Distribution; D003287:Contrast Media; D017023:Coronary Angiography; D005260:Female; D019786:Gadolinium DTPA; D006470:Hemorrhage / Q000209:etiology / Q000473:pathology* / Q000628:therapy; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D016015:Logistic Models; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000473:pathology* / Q000628:therapy; D015425:Myocardial Reperfusion; D009942:Organometallic Compounds; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; D010975:Platelet Aggregation Inhibitors; C090600:gadobutrol; D019786:Gadolinium DTPA