title: Residual Myocardial Iron Following Intramyocardial Hemorrhage During the Convalescent Phase of Reperfused ST-Segment-Elevation Myocardial Infarction and Adverse Left Ventricular Remodeling.
abstract: BACKGROUND
  The presence of intramyocardial hemorrhage (IMH) in ST-segment-elevation myocardial infarction patients reperfused by primary percutaneous coronary intervention has been associated with residual myocardial iron at follow-up, and its impact on adverse left ventricular (LV) remodeling is incompletely understood and is investigated here.
  
  
  RESULTS
  Forty-eight ST-segment-elevation myocardial infarction patients underwent cardiovascular magnetic resonance at 4±2 days post primary percutaneous coronary intervention, of whom 40 had a follow-up scan at 5±2 months. Native T1, T2, and T2* maps were acquired. Eight out of 40 (20%) patients developed adverse LV remodeling. A subset of 28 patients had matching T2* maps, of which 15/28 patients (54%) had IMH. Eighteen of 28 (64%) patients had microvascular obstruction on the acute scan, of whom 15/18 (83%) patients had microvascular obstruction with IMH. On the follow-up scan, 13/15 patients (87%) had evidence of residual iron within the infarct zone. Patients with residual iron had higher T2 in the infarct zone surrounding the residual iron when compared with those without. In patients with adverse LV remodeling, T2 in the infarct zone surrounding the residual iron was also higher than in those without (60 [54-64] ms versus 53 [51-56] ms; P=0.025). Acute myocardial infarct size, extent of microvascular obstruction, and IMH correlated with the change in LV end-diastolic volume (Pearson's rho of 0.64, 0.59, and 0.66, respectively; P=0.18 and 0.62, respectively, for correlation coefficient comparison) and performed equally well on receiver operating characteristic curve for predicting adverse LV remodeling (area under the curve: 0.99, 0.94, and 0.95, respectively; P=0.19 for receiver operating characteristic curve comparison).
  
  
  CONCLUSIONS
  The majority of ST-segment-elevation myocardial infarction patients with IMH had residual myocardial iron at follow-up. This was associated with persistently elevated T2 values in the surrounding infarct tissue and adverse LV remodeling. IMH and residual myocardial iron may be potential therapeutic targets for preventing adverse LV remodeling in reperfused ST-segment-elevation myocardial infarction patients.
authors.affiliation: From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., S.K.W., M.R., A.H., D.M.Y., D.J.H.); National Institute of Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (H.B., S.K.W., M.R., A.H., A.S., D.M.Y., J.C.M., D.J.H.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (H.B., S.R., A.A.-G., S.K.W., A.N.B., T.A.T., M.F., M.R., A.H., A.S., A.S.H., C.M., J.C.M., D.J.H.); National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore (D.J.H.).
authors.forename: Heerajnarain
authors.initials: H
authors.lastname: Bulluck
authors.affiliation: From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., S.K.W., M.R., A.H., D.M.Y., D.J.H.); National Institute of Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (H.B., S.K.W., M.R., A.H., A.S., D.M.Y., J.C.M., D.J.H.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (H.B., S.R., A.A.-G., S.K.W., A.N.B., T.A.T., M.F., M.R., A.H., A.S., A.S.H., C.M., J.C.M., D.J.H.); National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore (D.J.H.).
authors.forename: Stefania
authors.initials: S
authors.lastname: Rosmini
authors.affiliation: From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., S.K.W., M.R., A.H., D.M.Y., D.J.H.); National Institute of Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (H.B., S.K.W., M.R., A.H., A.S., D.M.Y., J.C.M., D.J.H.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (H.B., S.R., A.A.-G., S.K.W., A.N.B., T.A.T., M.F., M.R., A.H., A.S., A.S.H., C.M., J.C.M., D.J.H.); National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore (D.J.H.).
authors.forename: Amna
authors.initials: A
authors.lastname: Abdel-Gadir
authors.affiliation: From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., S.K.W., M.R., A.H., D.M.Y., D.J.H.); National Institute of Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (H.B., S.K.W., M.R., A.H., A.S., D.M.Y., J.C.M., D.J.H.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (H.B., S.R., A.A.-G., S.K.W., A.N.B., T.A.T., M.F., M.R., A.H., A.S., A.S.H., C.M., J.C.M., D.J.H.); National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore (D.J.H.).
authors.forename: Steven K
authors.initials: SK
authors.lastname: White
authors.affiliation: From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., S.K.W., M.R., A.H., D.M.Y., D.J.H.); National Institute of Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (H.B., S.K.W., M.R., A.H., A.S., D.M.Y., J.C.M., D.J.H.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (H.B., S.R., A.A.-G., S.K.W., A.N.B., T.A.T., M.F., M.R., A.H., A.S., A.S.H., C.M., J.C.M., D.J.H.); National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore (D.J.H.).
authors.forename: Anish N
authors.initials: AN
authors.lastname: Bhuva
authors.affiliation: From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., S.K.W., M.R., A.H., D.M.Y., D.J.H.); National Institute of Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (H.B., S.K.W., M.R., A.H., A.S., D.M.Y., J.C.M., D.J.H.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (H.B., S.R., A.A.-G., S.K.W., A.N.B., T.A.T., M.F., M.R., A.H., A.S., A.S.H., C.M., J.C.M., D.J.H.); National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore (D.J.H.).
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Treibel
authors.affiliation: From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., S.K.W., M.R., A.H., D.M.Y., D.J.H.); National Institute of Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (H.B., S.K.W., M.R., A.H., A.S., D.M.Y., J.C.M., D.J.H.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (H.B., S.R., A.A.-G., S.K.W., A.N.B., T.A.T., M.F., M.R., A.H., A.S., A.S.H., C.M., J.C.M., D.J.H.); National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore (D.J.H.).
authors.forename: Marianna
authors.initials: M
authors.lastname: Fontana
authors.affiliation: From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., S.K.W., M.R., A.H., D.M.Y., D.J.H.); National Institute of Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (H.B., S.K.W., M.R., A.H., A.S., D.M.Y., J.C.M., D.J.H.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (H.B., S.R., A.A.-G., S.K.W., A.N.B., T.A.T., M.F., M.R., A.H., A.S., A.S.H., C.M., J.C.M., D.J.H.); National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore (D.J.H.).
authors.forename: Manish
authors.initials: M
authors.lastname: Ramlall
authors.affiliation: From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., S.K.W., M.R., A.H., D.M.Y., D.J.H.); National Institute of Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (H.B., S.K.W., M.R., A.H., A.S., D.M.Y., J.C.M., D.J.H.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (H.B., S.R., A.A.-G., S.K.W., A.N.B., T.A.T., M.F., M.R., A.H., A.S., A.S.H., C.M., J.C.M., D.J.H.); National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore (D.J.H.).
authors.forename: Ashraf
authors.initials: A
authors.lastname: Hamarneh
authors.affiliation: From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., S.K.W., M.R., A.H., D.M.Y., D.J.H.); National Institute of Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (H.B., S.K.W., M.R., A.H., A.S., D.M.Y., J.C.M., D.J.H.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (H.B., S.R., A.A.-G., S.K.W., A.N.B., T.A.T., M.F., M.R., A.H., A.S., A.S.H., C.M., J.C.M., D.J.H.); National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore (D.J.H.).
authors.forename: Alex
authors.initials: A
authors.lastname: Sirker
authors.affiliation: From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., S.K.W., M.R., A.H., D.M.Y., D.J.H.); National Institute of Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (H.B., S.K.W., M.R., A.H., A.S., D.M.Y., J.C.M., D.J.H.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (H.B., S.R., A.A.-G., S.K.W., A.N.B., T.A.T., M.F., M.R., A.H., A.S., A.S.H., C.M., J.C.M., D.J.H.); National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore (D.J.H.).
authors.forename: Anna S
authors.initials: AS
authors.lastname: Herrey
authors.affiliation: From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., S.K.W., M.R., A.H., D.M.Y., D.J.H.); National Institute of Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (H.B., S.K.W., M.R., A.H., A.S., D.M.Y., J.C.M., D.J.H.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (H.B., S.R., A.A.-G., S.K.W., A.N.B., T.A.T., M.F., M.R., A.H., A.S., A.S.H., C.M., J.C.M., D.J.H.); National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore (D.J.H.).
authors.forename: Charlotte
authors.initials: C
authors.lastname: Manisty
authors.affiliation: From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., S.K.W., M.R., A.H., D.M.Y., D.J.H.); National Institute of Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (H.B., S.K.W., M.R., A.H., A.S., D.M.Y., J.C.M., D.J.H.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (H.B., S.R., A.A.-G., S.K.W., A.N.B., T.A.T., M.F., M.R., A.H., A.S., A.S.H., C.M., J.C.M., D.J.H.); National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore (D.J.H.).
authors.forename: Derek M
authors.initials: DM
authors.lastname: Yellon
authors.affiliation: From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., S.K.W., M.R., A.H., D.M.Y., D.J.H.); National Institute of Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (H.B., S.K.W., M.R., A.H., A.S., D.M.Y., J.C.M., D.J.H.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (H.B., S.R., A.A.-G., S.K.W., A.N.B., T.A.T., M.F., M.R., A.H., A.S., A.S.H., C.M., J.C.M., D.J.H.); National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore (D.J.H.).
authors.forename: Peter
authors.initials: P
authors.lastname: Kellman
authors.affiliation: From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., S.K.W., M.R., A.H., D.M.Y., D.J.H.); National Institute of Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (H.B., S.K.W., M.R., A.H., A.S., D.M.Y., J.C.M., D.J.H.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (H.B., S.R., A.A.-G., S.K.W., A.N.B., T.A.T., M.F., M.R., A.H., A.S., A.S.H., C.M., J.C.M., D.J.H.); National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore (D.J.H.).
authors.forename: James C
authors.initials: JC
authors.lastname: Moon
authors.affiliation: From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., S.K.W., M.R., A.H., D.M.Y., D.J.H.); National Institute of Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (H.B., S.K.W., M.R., A.H., A.S., D.M.Y., J.C.M., D.J.H.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (H.B., S.R., A.A.-G., S.K.W., A.N.B., T.A.T., M.F., M.R., A.H., A.S., A.S.H., C.M., J.C.M., D.J.H.); National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore (D.J.H.). derek.hausenloy@duke-nus.edu.sg.
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Hausenloy
mesh_terms: D000368:Aged; D019540:Area Under Curve; D003326:Coronary Circulation; D005260:Female; D006470:Hemorrhage / Q000209:etiology* / Q000378:metabolism; D006801:Humans; D007501:Iron / Q000378:metabolism*; D008279:Magnetic Resonance Imaging; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism* / Q000473:pathology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
chemical_list: D007501:Iron
keywords: ST-segment–; T2 mapping; T2* mapping; elevation myocardial infarction; intramyocardial hemorrhage; residual myocardial iron