Abstract 18191: Myocardial Haemorrhage Following Reperfused Acute Myocardial Infarction is a Predictor of Adverse Left Ventricular Remodelling and Late Ventricular Arrhythmia
Background: Reperfusion of severely ischaemic myocardium can lead to interstitial haemorrhage due to irreversible vascular injury. Haemorrhagic infarction can be detected in vivo by cardiovascular magnetic resonance (CMR) as hypointense signal on T2-weighted (T2W) and T2* imaging. However, the clinical implications of myocardial haemorrhage following acute myocardial infarction (AMI) remain undetermined.
Objectives: To assess whether the presence of myocardial haemorrhage influences ventricular remodelling and risk of late ventricular arrhythmia following primary percutaneous coronary intervention (PPCI) for acute myocardial infarction (AMI).
Methods: Forty-eight patients with first ST elevation AMI, treated successfully with PPCI, underwent CMR at day 2 and 3 months. Left ventricular end-diastolic volume (LVEDV), end-systolic volume (LVESV) and ejection fraction (LVEF) were determined from cine-CMR, infarct size and microvascular obstruction (MVO) from gadolinium enhanced images and area at risk (AAR) from T2W-CMR. Myocardial haemorrhage was defined as hypointense signal within the AAR on both T2W and T2* images. All patients had a signal-averaged electrocardiogram at three months.
Results: 30/48 (63%) patients had MVO and 12 of these showed myocardial haemorrhage by T2W and T2* CMR. Patients with haemorrhagic MI had significantly larger LVEDV and LVESV, lower LVEF and larger infarcts than those with non-haemorrhagic MI at baseline and at 3 months. The presence of haemorrhage was an independent predictor of adverse remodelling, defined as increased LVESV on follow-up (p= 0.001, Hazard Ratio (HR) 1.6). Haemorrhagic infarction was also an independent predictor of a prolonged filtered QRS duration (i.e. >120ms) on signal-averaged ECG at 3 months (p=0.020, HR 1.176).
Conclusions: Myocardial haemorrhage, following reperfused AMI, is common and may be detected by T2W and T2* CMR. Reperfusion haemorrhage is associated with larger infarct size, lower LV ejection fraction and adverse ventricular remodelling. Haemorrhagic infarction is also associated with significant prolongation of QRS duration on signal-averaged electrocardiography and this may predict a greater risk of ventricular arrhythmia in this group of patients.
- © 2010 by American Heart Association, Inc.