title: Serial assessments of microvascular obstruction by contrast-enhanced magnetic resonance predict contractile recovery and clinical outcome after reperfused acute myocardial infarction.
abstract: OBJECTIVE
  The purpose of the study was to investigate, using cardiac magnetic resonance (CMR), the presence and time course of microvascular obstruction (MO) in patients with acute myocardial infarction (AMI), and to test its relationship with cardiac remodeling and clinical outcomes.
  
  
  RESULTS
  53 patients with AMI and successful percutaneous reperfusion underwent CMR examination at four separate timepoints: within the first 48 hours, at 10 days, at six and twelve months after infarction. MO was quantified immediately (early imaging) and 10 minutes (late imaging) after contrast administration in each session. The extent of MO decreased from early to late imaging at both the first and the second CMR exam (p≤0.001). Early MO was absent in 18(36%) patients both at 48 hours and 10 days after AMI. At 1 year follow-up, LVEF in these patients improved to normal (median = 62% (53-70)). Early MO was present in the first but not in the second CMR in 13 (26%) patients; LVEF at one year in these patients reached a median = 52% (47-61). Finally, Early MO was present in both exams in 19 (38%) patients, who at 1 year after infarction had a LVEF of median = 49% (42-54, P≤0.001 across groups). The time course of MO was a predictor of prognosis upon Kaplan-Meier analysis (P = 0.035). The presence of MO at 10 days after AMI was associated with a higher risk of MACE during a 5-years follow-up.
  
  
  CONCLUSIONS
  The presence of MO within 48 hours after AMI, and its time course in the following ten days, provides complementary information on both functional myocardial recovery and long-term outcome.
authors.affiliation: Department of Internal Medicine II, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Nico
authors.initials: N
authors.lastname: Abegunewardene
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Karl-Friedrich
authors.initials: KF
authors.lastname: Kreitner
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Katja
authors.initials: K
authors.lastname: Oberholzer
authors.affiliation: Department of Internal Medicine II, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Vosseler
authors.affiliation: Department of Internal Medicine II, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Kai-Helge
authors.initials: KH
authors.lastname: Schmidt
authors.affiliation: Department of Internal Medicine II, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Eva
authors.initials: E
authors.lastname: Wimmer
authors.affiliation: Institute for Medical Biometry, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Amelie
authors.initials: A
authors.lastname: Elsäßer
authors.affiliation: Department of Internal Medicine II, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Gori
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Düber
authors.affiliation: Department of Internal Medicine II, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Münzel
authors.affiliation: Department of Internal Medicine II, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Horstick
mesh_terms: D003287:Contrast Media / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging*; D011379:Prognosis; D011446:Prospective Studies; D015424:Reperfusion
chemical_list: D003287:Contrast Media
keywords: Acute myocardial infarction; magnetic resonance imaging; microvascular obstruction; prognosis