Clinical associations of microvascular obstruction and intramyocardial hemorrhage on cardiovascular magnetic resonance in patients with acute ST segment elevation myocardial infarction (STEMI)

Figures

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  Figure 1. Representative images of PPCI and the corresponding cardiovascular magnetic resonances. (A) In Case 1, a 61-year-old man was admitted to the hospital 1 hours after symptom onset. The culprit artery was the LCX, and his pre-and post-PPCI TIMI flow statuses were II and III, respectively. Post-PPCI CMR revealed LGE (+) at the inferior wall of the LV, without MVO and IMH. (B) In Case2,a 50-year-old man was admitted to the hospital 4 h after symptom onset. The culprit artery was the LAD, and his pre- and post-PPCI TIMI flow statuses were I and III, respectively. Post-PPCI CMR revealed a lesion and both MVO (+) and IMH (+) on the anterior wall of the LV. (C) In Case3, a 64-year-old man was admitted to the hospital 9 hours after symptom onset. Here the culprit artery was the RCA. His pre-and post-PPCI TIMI flow statuses were 0 and III, respectively. Post-PPCI CMR revealed a lesion that was MVO (+) but IMH (−) on the inferior wall of the LV. All culprit arteries are identified with black triangles, and the infarction regions identified on CMR are marked with white triangles. 4ch = 4 chamber view, CMR = cardiovascular magnetic resonance, IMH = intramyocardial hemorrhage, LAD = left…

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  Figure 2. Representative CMR images of patients stratified by the presence of MVO and IMH. All images depict the SAX view at the middle of the left ventricle. The upper 3 scans were obtained with the LGE sequence, and the lower 3 depict the color-maps yielded byT2∗ scans. Purple asterisks indicate myocardium with LGE, blue arrows indicate regions with MVO, and white 4-pointed stars indicate regions with IMH, which appeared as areas of low signal on T2∗sequences. CMR = cardiovascular magnetic resonance, IMH = intramyocardial hemorrhage, LGE = late-gadolinium enhancement, MVO = microvascular obstruction, PPCI = primary percutaneous coronary intervention, SAX = short axial view.

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  Figure 3. The results of linear regression and multivariate regression analyses. (A) Linear regression analysis of the sizes of IMH and MVO (r = 0.81). (B) Linear regression analysis of the sizes of MVO and LGE in the presence or absence of IMH. (C) Multivariate regression analysis. (D) Bubble plot demonstrating the potential use of 2 quantitative factors, the sizes of MVO and LGE, to predict the presence of IMH. IMH = intramyocardial hemorrhage, LGE = late-gadolinium enhancement, MVO = microvascular obstruction.

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  Figure 4. Density plot of the presence of MVO and IMH among patients admitted at different time intervals after symptom onset. IMH = intramyocardial hemorrhage, MVO = microvascular obstruction.