From the Division of Cardiology, Department of Medicine (K.C.W., L.A.B.,
S.P.S., R.S.B., J.A.C.L.) and the Division of Diagnostic Imaging, Department
of Radiology (E.A.Z., C.H.L.), The Johns Hopkins University School of
Medicine, Baltimore, Md, and The Feinberg Cardiovascular Research Institute
(R.M.J.), Northwestern University Medical School, Chicago, Ill.
Background—The extent of
microvascular obstruction during acute coronary occlusion may
determine the eventual magnitude of myocardial damage and thus, patient
prognosis after infarction. By contrast-enhanced MRI, regions of
profound microvascular obstruction at the infarct core are hypoenhanced
and correspond to greater myocardial damage acutely. We investigated
whether profound microvascular obstruction after infarction predicts
2-year cardiovascular morbidity and mortality.
Methods and Results—Forty-four patients underwent MRI 10±6 days
after infarction. Microvascular obstruction was defined as
hypoenhancement seen 1 to 2 minutes after contrast injection. Infarct
size was assessed as percent left ventricular mass
hyperenhanced 5 to 10 minutes after contrast. Patients were followed
clinically for 16±5 months. Seventeen patients returned 6 months after
infarction for repeat MRI. Patients with microvascular obstruction
(n=11) had more cardiovascular events than those
without (45% versus 9%; P=.016). In fact,
microvascular status predicted occurrence of
cardiovascular complications (
Conclusions—After infarction, MRI-determined microvascular
obstruction predicts more frequent cardiovascular
complications. In addition, infarct size determined by MRI also relates
directly to long-term prognosis in patients with acute myocardial
infarction. Moreover, microvascular status remains a strong prognostic
marker even after control for infarct size.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Prognostic Significance of Microvascular Obstruction by Magnetic Resonance Imaging in Patients With Acute Myocardial Infarction
2=6.46,
P<.01). The risk of adverse events increased with
infarct extent (30%, 43%, and 71% for small [n=10], midsized
[n=14], and large [n=14] infarcts, P<.05). Even
after infarct size was controlled for, the presence of microvascular
obstruction remained a prognostic marker of postinfarction
complications (2=5.17, P<.05). Among
those returning for follow-up imaging, the presence of microvascular
obstruction was associated with fibrous scar formation
(2=10.0, P<.01) and left
ventricular remodeling (P<.05).
Key Words: prognosis • microcirculation • magnetic resonance imaging
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