title: Temporal Evolution of Myocardial Hemorrhage and Edema in Patients After Acute ST-Segment Elevation Myocardial Infarction: Pathophysiological Insights and Clinical Implications.
abstract: BACKGROUND
  The time course and relationships of myocardial hemorrhage and edema in patients after acute ST-segment elevation myocardial infarction (STEMI) are uncertain.
  
  
  RESULTS
  Patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention underwent cardiac magnetic resonance imaging on 4 occasions: at 4 to 12 hours, 3 days, 10 days, and 7 months after reperfusion. Myocardial edema (native T2) and hemorrhage (T2*) were measured in regions of interest in remote and injured myocardium. Myocardial hemorrhage was taken to represent a hypointense infarct core with a T2* value <20 ms. Thirty patients with ST-segment elevation myocardial infarction (mean age 54 years; 25 [83%] male) gave informed consent. Myocardial hemorrhage occurred in 7 (23%), 13 (43%), 11 (33%), and 4 (13%) patients at 4 to 12 hours, 3 days, 10 days, and 7 months, respectively, consistent with a unimodal pattern. The corresponding median amounts of myocardial hemorrhage (percentage of left ventricular mass) during the first 10 days after myocardial infarction were 2.7% (interquartile range [IQR] 0.0-5.6%), 7.0% (IQR 4.9-7.5%), and 4.1% (IQR 2.6-5.5%; P<0.001). Similar unimodal temporal patterns were observed for myocardial edema (percentage of left ventricular mass) in all patients (P=0.001) and for infarct zone edema (T2, in ms: 62.1 [SD 2.9], 64.4 [SD 4.9], 65.9 [SD 5.3]; P<0.001) in patients without myocardial hemorrhage. Alternatively, in patients with myocardial hemorrhage, infarct zone edema was reduced at day 3 (T2, in ms: 51.8 [SD 4.6]; P<0.001), depicting a bimodal pattern. Left ventricular end-diastolic volume increased from baseline to 7 months in patients with myocardial hemorrhage (P=0.001) but not in patients without hemorrhage (P=0.377).
  
  
  CONCLUSIONS
  The temporal evolutions of myocardial hemorrhage and edema are unimodal, whereas infarct zone edema (T2 value) has a bimodal pattern. Myocardial hemorrhage is prognostically important and represents a target for therapeutic interventions that are designed to preserve vascular integrity following coronary reperfusion.
  
  
  BACKGROUND
  URL: https://clinicaltrials.gov/. Unique identifier: NCT02072850.
authors.affiliation: BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK Robertson Center for Biostatistics, University of Glasgow, UK.
authors.forename: David
authors.initials: D
authors.lastname: Carrick
authors.affiliation: West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Glasgow, UK.
authors.forename: Caroline
authors.initials: C
authors.lastname: Haig
authors.affiliation: BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK.
authors.forename: Nadeem
authors.initials: N
authors.lastname: Ahmed
authors.affiliation: BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK.
authors.forename: Samuli
authors.initials: S
authors.lastname: Rauhalammi
authors.affiliation: BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Clerfond
authors.affiliation: BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK.
authors.forename: Jaclyn
authors.initials: J
authors.lastname: Carberry
authors.affiliation: BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK.
authors.forename: Ify
authors.initials: I
authors.lastname: Mordi
authors.affiliation: Robertson Center for Biostatistics, University of Glasgow, UK.
authors.forename: Margaret
authors.initials: M
authors.lastname: McEntegart
authors.affiliation: BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK Robertson Center for Biostatistics, University of Glasgow, UK.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Petrie
authors.affiliation: Robertson Center for Biostatistics, University of Glasgow, UK.
authors.forename: Hany
authors.initials: H
authors.lastname: Eteiba
authors.affiliation: Robertson Center for Biostatistics, University of Glasgow, UK.
authors.forename: Stuart
authors.initials: S
authors.lastname: Hood
authors.affiliation: Robertson Center for Biostatistics, University of Glasgow, UK.
authors.forename: Stuart
authors.initials: S
authors.lastname: Watkins
authors.affiliation: Robertson Center for Biostatistics, University of Glasgow, UK.
authors.forename: M Mitchell
authors.initials: MM
authors.lastname: Lindsay
authors.affiliation: Robertson Center for Biostatistics, University of Glasgow, UK.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Mahrous
authors.affiliation: BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Welsh
authors.affiliation: BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK.
authors.forename: Naveed
authors.initials: N
authors.lastname: Sattar
authors.affiliation: West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Glasgow, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Ford
authors.affiliation: BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK Robertson Center for Biostatistics, University of Glasgow, UK.
authors.forename: Keith G
authors.initials: KG
authors.lastname: Oldroyd
authors.affiliation: BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Radjenovic
authors.affiliation: BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK Robertson Center for Biostatistics, University of Glasgow, UK colin.berry@glasgow.ac.uk.
authors.forename: Colin
authors.initials: C
authors.lastname: Berry
mesh_terms: D000328:Adult; D004489:Edema, Cardiac / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006470:Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D008137:Longitudinal Studies; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D015428:Myocardial Reperfusion Injury / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D009206:Myocardium / Q000473:pathology*; D015588:Observer Variation; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D013997:Time Factors; D016896:Treatment Outcome
keywords: magnetic resonance imaging; myocardial edema; myocardial hemorrhage; myocardial infarction; pathophysiology; reperfusion injury