Impact of microvascular obstruction on left ventricular local remodeling after reperfused myocardial infarction.
J Magn Reson Imaging
; 47(2): 499-510, 2018 02.
Article
en En
| MEDLINE
| ID: mdl-28580619
ABSTRACT
PURPOSE:
To evaluate by cardiac magnetic resonance imaging (MRI) the impact of microvascular obstruction (MVO) on regional left ventricular (LV) wall characteristics and local remodeling after acute myocardial infarction (AMI). MATERIALS ANDMETHODS:
In all, 114 AMI patients underwent cardiac MRI at 3T within 2-4 days (baseline) and at 6 months (follow-up) after reperfusion. Late gadolinium enhancement and cine sequences were performed. The impact of MVO (ie, presence and extent) on regional wall thickening (WT, %), end-diastolic wall thickness (EDWT, mm), and local cavity change (mm) of LV were quantitatively analyzed. Local cavity change, calculated as surface-to-surface distance from registered endocardial surface meshes of cine imaging datasets acquired initially and at follow-up, was used to assess local remodeling.RESULTS:
MVO was detected in 69 patients (60.5%). WT was significantly lower when MVO was present (P < 0.05); and it was inversely related to MVO transmural extent (P < 0.0001). WT improvement was significantly worsened when MVO was present in segments with infarct transmural extent exceeding 50%. Significant wall thinning occurred at follow-up in segments with infarct transmural extent >75% with further thinning by MVO presence; and EDWT decreased with increasing MVO transmural extent (P < 0.0001). LV cavity shrank in patients without MVO, whereas it dilated in those with MVO. Local cavity changes were not significantly different by a region-to-region analysis throughout the LV within each group (P = 0.57 and 0.74, respectively).CONCLUSION:
MVO has a significant adverse effect on LV wall characteristics and LV remodeling. Postinfarct remodeling seems to be globally mediated rather than locally mediated during the first 6 months. LEVEL OF EVIDENCE 2 Technical Efficacy Stage 3 J. Magn. Reson. Imaging 2018;47499-510.Palabras clave
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Reperfusión Miocárdica
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Remodelación Ventricular
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Ventrículos Cardíacos
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Microcirculación
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Infarto del Miocardio
Tipo de estudio:
Observational_studies
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Prognostic_studies
Límite:
Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
J Magn Reson Imaging
Asunto de la revista:
DIAGNOSTICO POR IMAGEM
Año:
2018
Tipo del documento:
Article
País de afiliación:
Francia