Prognostic value at 5 years of microvascular obstruction after acute myocardial infarction assessed by cardiovascular magnetic resonance
Gert Klug,Agnes Mayr,Sonja Schenk,Regina Esterhammer,Michael Schocke,Michael Nocker,Werner Jaschke,Otmar Pachinger,Bernhard Metzler +8 more
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TLDR
Early MVO, as assessed by first-pass CMR, is an independent long-term prognosticator for morbidity after AMI.Abstract:
Early and late microvascular obstruction (MVO) assessed by cardiovascular magnetic resonance (CMR) are prognostic markers for short-term clinical endpoints after acute ST-elevation myocardial infarction (STEMI). However, there is a lack of studies with long-term follow-up periods (>24 months). STEMI patients reperfused by primary angioplasty (n = 129) underwent MRI at a median of 2 days after the index event. Early MVO was determined on dynamic Gd first-pass images directly after the administration of 0.1 mmol/kg bodyweight Gd-based contrast agent. Furthermore, ejection fraction (EF, %), left ventricular myocardial mass (LVMM) and total infarct size (% of LVMM) were determined with CMR. Clinical follow-up was conducted after a median of 52 months. The primary endpoint was defined as a composite of death, myocardial re-infarction, stroke, repeat revascularization, recurrence of ischemic symptoms, atrial fibrillation, congestive heart failure and hospitalization. Follow-up was completed by 107 patients. 63 pre-defined events occurred during follow-up. Initially, 74 patients showed early MVO. Patients with early MVO had larger infarcts (mean: 24.9 g vs. 15.5 g, p = 0.002) and a lower EF (mean: 39% vs. 46%, p = 0.006). The primary endpoint occurred in 66.2% of patients with MVO and in 42.4% of patients without MVO (p < 0.05). The presence of early MVO was associated with a reduced event-free survival (log-rank p < 0.05). Early MVO was identified as the strongest independent predictor for the occurrence of the primary endpoint in the multivariable Cox regression analysis adjusting for age, ejection fraction and infarct size (hazard ratio: 2.79, 95%-CI 1.25-6.25, p = 0.012). Early MVO, as assessed by first-pass CMR, is an independent long-term prognosticator for morbidity after AMI.read more
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Coronary microvascular dysfunction: mechanisms and functional assessment.
TL;DR: The coronary microvasculature (vessels <300 μm in diameter) cannot be directly imaged in vivo, but a number of invasive and non-invasive techniques, each with relative advantages and pitfalls, can be used to assess parameters that depend directly on coronary microvascular function as discussed by the authors.
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Prognostic Value of Microvascular Obstruction and Infarct Size, as Measured by CMR in STEMI Patients
Matthijs van Kranenburg,Michael Magro,Holger Thiele,Suzanne de Waha,Ingo Eitel,Alexandre Cochet,Yves Cottin,Dan Atar,Peter Buser,Edwin Wu,Daniel C. Lee,Vicente Bodi,Gert Klug,Bernhard Metzler,Ronak Delewi,Peter Bernhardt,Wolfgang Rottbauer,Eric Boersma,Felix Zijlstra,Robert-Jan van Geuns +19 more
TL;DR: It is concluded that MO is an independent predictor of MACE and cardiac death, whereas IS%LV is not independently associated with MACE.
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Relationship between microvascular obstruction and adverse events following primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: an individual patient data pooled analysis from seven randomized trials.
Suzanne de Waha,Manesh R. Patel,Christopher B. Granger,E. Magnus Ohman,Akiko Maehara,Ingo Eitel,Ori Ben-Yehuda,Paul Jenkins,Holger Thiele,Gregg W. Stone +9 more
TL;DR: The presence and extent of MVO measured by CMR after primary PCI in STEMI are strongly associated with mortality and hospitalization for HF within 1 year and not significantly related to subsequent reinfarction.
Journal ArticleDOI
Effect of microvascular obstruction and intramyocardial hemorrhage by CMR on LV remodeling and outcomes after myocardial infarction: a systematic review and meta-analysis.
TL;DR: Late MVO is shown to be a stronger prognostic marker for MACE and cardiac death, recurrent MI, congestive heart failure/heart failure hospitalization, and follow-up LV end-systolic volumes than early MVO.
Journal ArticleDOI
No-reflow phenomenon: pathophysiology, diagnosis, prevention, and treatment. A review of the current literature and future perspectives.
Gennaro Galasso,Stephan Schiekofer,Carolina D'Anna,Giuseppe Di Gioia,Raffaele Piccolo,Tullio Niglio,Roberta De Rosa,Teresa Strisciuglio,Plinio Cirillo,Federico Piscione,Bruno Trimarco +10 more
TL;DR: The main pathophysiological mechanisms of no-reflow, its clinical manifestation, including the strong association with increased in-hospital mortality, malignant arrhythmias, and cardiac failure as well as the diagnostic methods are described.
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