ABSTRACT
INTRODUCTION AND OBJECTIVES: Late contrast-enhanced cardiac magnetic resonance (CMR) enables areas of persistent microvascular obstruction (PMO) to be detected early after acute myocardial infarction. Our aim was to evaluate the impact of PMO on subsequent ventricular remodeling in a cohort of patients with acute ST-elevation myocardial infarction (STEMI) who underwent intracoronary autologous bone-marrow mononuclear cell (ABMMC) transplantation. METHODS: In total, 14 patients underwent intracoronary transplantation of 66+/-39 x 10(6) ABMMCs 8+/-2 days following successful revascularization of a STEMI (i.e., TIMI flow grade 3 in the affected artery). Serial CMR studies with gadolinium-DTPA enhancement were performed at baseline and 10 months after infarction. Left ventricular volume and ejection fraction, regional contractility and the infarct size were measured and the presence of PMO (defined as hypoenhanced areas within the infarcted zone) was investigated. RESULTS: Overall, PMO was detected in five of the 14 patients (36%). Those with PMO tended to have a larger infarct size, larger ventricular volumes, and poorer regional and global left ventricular systolic function in baseline studies than those without PMO. At follow-up, there were significant associations between PMO and an increase in end-diastolic volume (25+/-24 mL vs. -2+/-19 mL; P=.037), the absence of an increase in end-diastolic parietal thickness (P=.027), and a smaller reduction in the number of akinetic or dyskinetic segments. CONCLUSIONS: The detection of PMO by CMR early after successful revascularization of a STEMI in patients who underwent intracoronary ABMMC transplantation was associated with adverse left ventricular remodeling.
Subject(s)
Bone Marrow Transplantation , Coronary Occlusion/complications , Coronary Occlusion/diagnosis , Magnetic Resonance Imaging , Myocardial Infarction/surgery , Ventricular Remodeling , Bone Marrow Transplantation/methods , Contrast Media , Coronary Vessels , Humans , Magnetic Resonance Imaging/methods , Male , Middle AgedABSTRACT
Introducción y objetivos. La cardiorresonancia magnéticacon realce tardío de contraste (RMc) permite la detecciónprecoz de obstrucción microvascular persistente(OMP) tras un infarto. Hemos analizado el impacto de laOMP en el remodelado ventricular de una cohorte de pacientes con infarto agudo de miocardio con ST elevado(IAMSTE) que recibieron implante intracoronario de células mononucleadas de médula ósea autóloga (CMMOA).Métodos. Catorce pacientes recibieron infusión intracoronaria de 66 ± 39 millones de CMMOA a los 8 ± 2 días de un IAMSTE revascularizado con éxito (flujo TIMI 3 epicárdico). Se realizaron estudios seriados de RMc con gadolinio- DTPA (basal y a los 10 meses del infarto), con análisis de volúmenes y fracción de eyección ventricular izquierda, motilidad regional, tamaño del infarto y presenciade OMP (definida como un área con ausencia de señalen el seno del infarto).Resultados. Se detectó OMP en 5 (36%) de los 14 pacientes,junto con una tendencia en el estudio basal a presentar un mayor tamaño del infarto, mayores volúmenes y peor función sistólica general y regional de ventrículo izquierdo respecto a aquellos sin OMP. En el seguimiento, la presencia de OMP se relacionó significativamente con un incremento en el volumen telediastólico (25 ± 24 frente a 2 ± 19 ml; p = 0,037), ausencia de incremento en el grosor telediastólico parietal (p = 0,027) y una menor reducciónen el número de segmentos acinéticos o discinéticos.Conclusiones. La OMP evaluada precozmente medianteRMc tras un IAMSTE revascularizado con éxito seasocia con un remodelado ventricular izquierdo adversoen pacientes sometidos a implante intracoronario de CMMOA
Introduction and objectives. Late contrast-enhancedcardiac magnetic resonance (CMR) enables areas ofpersistent microvascular obstruction (PMO) to bedetected early after acute myocardial infarction. Our aimwas to evaluate the impact of PMO on subsequentventricular remodeling in a cohort of patients with acuteST-elevation myocardial infarction (STEMI) whounderwent intracoronary autologous bone-marrowmononuclear cell (ABMMC) transplantation.Methods. In total, 14 patients underwent intracoronarytransplantation of 66±39 × 106 ABMMCs 8±2 daysfollowing successful revascularization of a STEMI (i.e.,TIMI flow grade 3 in the affected artery). Serial CMRstudies with gadolinium-DTPA enhancement wereperformed at baseline and 10 months after infarction. Left ventricular volume and ejection fraction, regionalcontractility and the infarct size were measured and thepresence of PMO (defined as hypoenhanced areas withinthe infarcted zone) was investigated.Results. Overall, PMO was detected in five of the 14patients (36%). Those with PMO tended to have a largerinfarct size, larger ventricular volumes, and poorer regional and global left ventricular systolic function in baseline studies than those without PMO. At follow-up, there were significant associations between PMO and an increase in end-diastolic volume (25±24 mL vs. 2±19 mL; P=.037), the absence of an increase in end-diastolic parietal thickness (P=.027), and a smaller reduction in the number of akinetic or dyskinetic segments.Conclusions. The detection of PMO by CMR earlyafter successful revascularization of a STEMI in patientswho underwent intracoronary ABMMC transplantationwas associated with adverse left ventricular remodeling
Subject(s)
Humans , Capillary Permeability , Myocardial Infarction/surgery , Cell- and Tissue-Based Therapy/methods , Ventricular Remodeling , Bone Marrow Cells , Myocardial Reperfusion/methods , Magnetic Resonance Spectroscopy/methodsABSTRACT
INTRODUCTION AND OBJECTIVES: In general, magnetic resonance imaging is contraindicated when the patient has a ferromagnetic prosthesis or implant. With coronary stents, there is a theoretical concern that use of magnetic resonance imaging shortly after implantation will dislodge the stent, thereby increasing the risk of thrombosis. However, the risk may be overestimated because modern coronary stents are not ferromagnetic or are only weakly so. The objective of this study was to determine whether carrying out cardiac magnetic resonance imaging shortly after stent implantation is a safe procedure in acute myocardial infarction patients. METHODS: We carried out a retrospective study of 407 patients with ST-elevation acute myocardial infarction who were treated by stent implantation. Cardiac magnetic resonance imaging was performed in the first 14 (11) days after stent implantation in 86 of these 407 patients (group 1); it was not performed in the 321 patients in group 2. The occurrence of an adverse event, such as death, reinfarction, or revascularization, either in hospital or after 6 or 12 months was recorded. RESULTS: Three patients experienced subacute stent thrombosis, all in group 2. No statistically significant difference in any other variable was found. The combined rate of death, reinfarction, revascularization, or rehospitalization at 12 months was 14% in group 1 and 16% in group 2 (P=.7). CONCLUSIONS: Carrying out cardiac magnetic resonance imaging shortly after stent implantation in acute myocardial infarction patients appears to be a safe procedure.
Subject(s)
Magnetic Resonance Imaging/adverse effects , Myocardial Infarction/surgery , Safety , Stents , Contraindications , Creatine Kinase, BB Form/blood , Female , Humans , Male , Middle Aged , Recurrence , Retrospective StudiesABSTRACT
Introducción y objetivos. La resonancia magnética está de forma general contraindicada cuando hay algún tipo de prótesis o implante de metal ferromagnético. En el caso del stent coronario, hay una teórica preocupación de que la realización precoz de una resonancia magnética produzca desplazamiento del stent, lo que aumentaría el riesgo de trombosis. Este riesgo puede estar sobrestimado, ya que los stents de última generación no son ferromagnéticos o lo son muy poco. El objetivo de este estudio es comprobar si la realización precoz de una resonancia cardiaca tras el implante de stent es un procedimiento seguro para el paciente tras un infarto agudo de miocardio. Métodos. Estudio retrospectivo de 407 pacientes con infarto agudo de miocardio con elevación del segmento ST tratados con stent. Se realizó un estudio de resonancia cardiaca en los primeros 14 ± 11 días en 86 pacientes (grupo 1); el grupo 2 está formado por los 321 restantes. Se realizó un seguimiento de eventos adversos, incluidos el reinfarto, la muerte o la revascularización intrahospitalaria, y a los 6 y 12 meses. Resultados. Se registraron 3 casos de oclusión trombótica subaguda del stent, todos en el grupo 2. No se encontraron diferencias significativas para el resto de las variables. El evento combinado muerte, reinfarto, revascularización y rehospitalización al año fue del 14% en el grupo 1 y del 16% en el grupo 2 (p = 0,7). Conclusiones. La realización precoz de un estudio con resonancia magnética cardiaca parece ser un procedimiento seguro en pacientes que han sido tratados mediante implante de stent tras un infarto agudo de miocardio
Introduction and objectives. In general, magnetic resonance imaging is contraindicated when the patient has a ferromagnetic prosthesis or implant. With coronary stents, there is a theoretical concern that use of magnetic resonance imaging shortly after implantation will dislodge the stent, thereby increasing the risk of thrombosis. However, the risk may be overestimated because modern coronary stents are not ferromagnetic or are only weakly so. The objective of this study was to determine whether carrying out cardiac magnetic resonance imaging shortly after stent implantation is a safe procedure in acute myocardial infarction patients. Methods. We carried out a retrospective study of 407 patients with ST-elevation acute myocardial infarction who were treated by stent implantation. Cardiac magnetic resonance imaging was performed in the first 14 (11) days after stent implantation in 86 of these 407 patients (group 1); it was not performed in the 321 patients in group 2. The occurrence of an adverse event, such as death, reinfarction, or revascularization, either in hospital or after 6 or 12 months was recorded. Results. Three patients experienced subacute stent thrombosis, all in group 2. No statistically significant difference in any other variable was found. The combined rate of death, reinfarction, revascularization, or rehospitalization at 12 months was 14% in group 1 and 16% in group 2 (P=.7). Conclusions. Carrying out cardiac magnetic resonance imaging shortly after stent implantation in acute myocardial infarction patients appears to be a safe procedure
