From the Cardiology Division, Department of Medicine (C.E.R., J.A.C.L.,
T.F., L.C.B.); Department of Radiology (J.A.C.L., D.A.B., E.R.M.); and
Department of Biomedical Engineering (E.R.M., S.B.R.), Johns Hopkins
University, Baltimore, Md, and the Division of Cardiology, Department of
Medicine, University of Louvain, Brussels, Belgium (J.A.M.).
Correspondence to João A.C. Lima, MD, Johns Hopkins Hospital, Cardiology Division, Blalock 569, 600 N Wolfe St, Baltimore, MD 21287-6568. E-mail jlima{at}welchlink.welch.jhu.edu
Background—Microvascular obstruction
within an area of myocardial infarction indicates worse functional
recovery and a higher risk of postinfarction complications. After
prolonged coronary occlusion, contrast-enhanced MRI identifies
myocardial infarction as a hyperenhanced region containing a
hypoenhanced core. Because the time course of microvascular obstruction
after infarction/reperfusion is unknown, we examined whether
microvascular obstruction reaches its full extent shortly after
reperfusion or shows significant progression over the following 2
days.
Methods and Results—Seven dogs underwent 90-minute balloon
occlusion of the left anterior descending coronary artery (LAD)
followed by reflow. Gadolinium-DTPA–enhanced MRI performed at 2, 6,
and 48 hours after reperfusion was compared with radioactive
microsphere blood flow (MBF) measurements and myocardial
staining to define microvascular obstruction (thioflavin S) and infarct
size (triphenyltetrazolium chloride, TTC).
The MRI hypoenhanced region increased 3-fold during 48 hours after
reperfusion (3.2±1.8%, 6.7±4.4%, and 9.9±3.2% of left
ventricular mass at 2, 6, and 48 hours, respectively,
P<0.03) and correlated well with microvascular
obstruction (MBF <50% of remote region, r=0.99 and
thioflavin S, r=0.93). MRI hyperenhancement also
increased (21.7±4.0%, 24.3±4.6%, and 28.8±5.1% at 2, 6, and 48
hours, P<0.006) and correlated well with infarct size
by TTC (r=0.92). The microvascular obstruction/infarct
size ratio increased from 13.0±4.8% to 22.6±8.9% and to 30.4±4.2%
over 48 hours (P=0.024).
Conclusions—The extent of microvascular obstruction and the
infarct size increase significantly over the first 48 hours after
myocardial infarction. These results are consistent with
progressive microvascular and myocardial injury well beyond
coronary occlusion and reflow.
© 1998 American Heart Association, Inc.
Basic Science Reports
Magnitude and Time Course of Microvascular Obstruction and Tissue Injury After Acute Myocardial Infarction
Key Words: magnetic resonance imaging • myocardial infarction • microcirculation • reperfusion • perfusion
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B. L. Gerber, C. E. Rochitte, D. A. Bluemke, J. A. Melin, P. Crosille, L. C. Becker, and J. A.C. Lima Relation Between Gd-DTPA Contrast Enhancement and Regional Inotropic Response in the Periphery and Center of Myocardial Infarction Circulation, August 28, 2001; 104(9): 998 - 1004. [Abstract] [Full Text] [PDF]
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S. B. Reeder, Y. P. Du, J. A. C. Lima, and D. A. Bluemke Advanced Cardiac MR Imaging of Ischemic Heart Disease RadioGraphics, July 1, 2001; 21(4): 1047 - 1074. [Abstract] [Full Text] [PDF]
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R. Hattori, H. Otani, Y. Moriguchi, H. Matsubara, T. Yamamura, Y. Nakao, H. Omiya, M. Osako, and H. Imamura NHE and ICAM-1 expression in hypoxic/reoxygenated coronary microvascular endothelial cells Am J Physiol Heart Circ Physiol, June 1, 2001; 280(6): H2796 - H2803. [Abstract] [Full Text] [PDF]
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U. Sechtem Imaging myocardial area at risk and final infarct size Eur. Heart J. Suppl., June 1, 2001; 3(suppl_C): C36 - C46. [PDF]
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E Eeckhout and M.J Kern The coronary no-reflow phenomenon: a review of mechanisms and therapies Eur. Heart J., May 1, 2001; 22(9): 729 - 739. [PDF]
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 M. Saeed New Concepts in Characterization of Ischemically Injured Myocardium by MRI Experimental Biology and Medicine, May 1, 2001; 226(5): 367 - 376. [Abstract] [Full Text]
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O. P. Simonetti, R. J. Kim, D. S. Fieno, H. B. Hillenbrand, E. Wu, J. M. Bundy, J. P. Finn, and R. M. Judd An Improved MR Imaging Technique for the Visualization of Myocardial Infarction Radiology, January 1, 2001; 218(1): 215 - 223. [Abstract] [Full Text]
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D. S. Fieno, R. J. Kim, E.-L. Chen, J. W. Lomasney, F. J. Klocke, and R. M. Judd Contrast-enhanced magnetic resonance imaging of myocardium at risk: Distinction between reversible and irreversible injury throughout infarct healing J. Am. Coll. Cardiol., November 15, 2000; 36(6): 1985 - 1991. [Abstract] [Full Text] [PDF]
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C. E. Rochitte, R. J. Kim, H. B. Hillenbrand, E.-l. Chen, and J. A. C. Lima Microvascular Integrity and the Time Course of Myocardial Sodium Accumulation After Acute Infarction Circ. Res., October 13, 2000; 87(8): 648 - 655. [Abstract] [Full Text] [PDF]
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J. M Budde, D. A Velez, Z.-Q. Zhao, K. L Clark, C. D Morris, S. Muraki, R. A Guyton, and J. Vinten-Johansen Comparative study of AMP579 and adenosine in inhibition of neutrophil-mediated vascular and myocardial injury during 24 h of reperfusion Cardiovasc Res, August 1, 2000; 47(2): 294 - 305. [Abstract] [Full Text] [PDF]
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B. L. Gerber, C. E. Rochitte, J. A. Melin, E. R. McVeigh, D. A. Bluemke, K. C. Wu, L. C. Becker, and J. A. C. Lima Microvascular Obstruction and Left Ventricular Remodeling Early After Acute Myocardial Infarction Circulation, June 13, 2000; 101(23): 2734 - 2741. [Abstract] [Full Text] [PDF]
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J. E. Jordan, Z.-Q. Zhao, and J. Vinten-Johansen The role of neutrophils in myocardial ischemia-reperfusion injury Cardiovasc Res, September 1, 1999; 43(4): 860 - 878. [Abstract] [Full Text] [PDF]
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K. C. Wu, R. J. Kim, D. A. Bluemke, C. E. Rochitte, E. A. Zerhouni, L. C. Becker, and J. A. C. Lima Quantification and time course of microvascular obstruction by contrast-enhanced echocardiography and magnetic resonance imaging following acute myocardial infarction and reperfusion J. Am. Coll. Cardiol., November 15, 1998; 32(6): 1756 - 1764. [Abstract] [Full Text] [PDF]
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