Microvascular obstruction remains a portent of adverse remodeling in optimally treated patients with left ventricular systolic dysfunction after acute myocardial infarction

Weir, Robin A.P.; Murphy, Charles Aengus; Petrie, Colin J.; Martin, Thomas N.; Balmain, Sean; Clements, Suzanne; Steedman, Tracey; Wagner, Galen S.; Dargie, Henry J.; McMurray, John J.V.

doi:10.1161/circimaging.109.897439

Cited by 86Cardiac Imaging and DiagnosticsCardiac Fibrosis and RemodelingCardiomyopathy and Myosin Studies

Microvascular obstruction remains a portent of adverse remodeling in optimally treated patients with left ventricular systolic dysfunction after acute myocardial infarction

Weir, Robin A.P., Murphy, Charles Aengus, Petrie, Colin J., Martin, Thomas N., Balmain, Sean, Clements, Suzanne, Steedman, Tracey, Wagner, Galen S. +2 more·2010·Circulation Cardiovascular Imaging

DOI 10.1161/circimaging.109.897439

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Abstract

BACKGROUND: Microvascular obstruction (MO) is associated with large acute myocardial infarction and lower left ventricular (LV) ejection fraction and predicts greater remodeling, but whether this effect is abolished by contemporary antiremodeling therapies is subject to debate. We examined the influence of several infarct characteristics, including MO, on LV remodeling in an optimally treated post-acute myocardial infarction cohort, using contrast-enhanced cardiac magnetic resonance. METHODS AND RESULTS: One hundred patients (mean age, 58.9+/-12 years, 77%men) underwent contrast-enhanced cardiac magnetic resonance at baseline (approximately 4 days) and at 12 and 24 weeks. The effects on LV remodeling (ie, change in LV end-systolic volume index [DeltaLVESVi]) of infarct site, transmurality, endocardial extent, and the presence of early and late MO were analyzed. Mean baseline infarct volume index decreased from 34.0 (21.2) mL/m(2) to 20.9 (12.9) mL/m(2) at 24 weeks (P<0.001). Infarct site had no influence on remodeling, but greater baseline infarct transmurality (r=0.47, P<0.001) and endocardial extent (r=0.26, P<0.01) were associated with higher DeltaLVESVi. Early MO was seen in 69 patients (69%) and persisted as late MO in 56 patients (56%). Patients with late MO underwent significantly greater remodeling than those without MO (DeltaLVESVi, +4.1 [13.4] versus -7.0 [12.7] mL/m(2), respectively, P=0.001); those with early MO only displayed an intermediate DeltaLVESVi (-4.9 [13.0] mL/m(2)). Importantly, late MO was seen frequently despite optimal coronary blood flow having been restored at angiography. CONCLUSIONS: Late MO on predischarge contrast-enhanced cardiac magnetic resonance remains an ominous predictor of adverse LV remodeling despite powerful antiremodeling therapy and may be useful in the risk stratification of survivors of acute myocardial infarction.

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Reperfusion failure occurs in approximately 30% of patients with acute MI despite successful revascularization.
“Despite the successful revascularization of occluded vessels in the heart, reperfusion failure occurs in approximately 30% of patients with acute MI [177,178].”
From AMPK, Mitochondrial Function, and Cardiovascular Disease (2020) · cites this paper as [178]

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Microvascular Obstruction and Left Ventricular Remodeling Early After Acute Myocardial Infarction
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121 Patients with persistent microvascular obstruction following acute myocardial infarction remain at high risk of adverse remodelling despite optimal medical therapy and may benefit from aldosterone antagonism
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Microvascular obstruction by delayed contrast-enhanced MRI remains a strong predictor of left ventricular remodeling even after successful reperfusion in acute myocardial infarction
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Impact of microvascular obstruction on left ventricular local remodeling after reperfused myocardial infarction
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009 Impact of early vs late microvascular obstruction on ventricular remodeling at 6 months assessed by 3-Tesla magnetic resonance imaging in acute myocardial infarction
Meneveau, N. F., Chopard, R., Seronde, M., Descotes‐Genon, V., Jehl, J., Comte, A., Schiele, F., & Kastler, B. A. (2011) · Archives of Cardiovascular Diseases Supplements · doi:10.1016/s1878-6480(11)70011-8

Authors: Weir, R. A. P., Murphy, C. A., Petrie, C. J., Martin, T. N., Balmain, S., Clements, S., Steedman, T., Wagner, G. S., Dargie, H. J., & McMurray, J. J. V.
Affiliations: Duke University (US)
ORCID: Weir, Robin A.P.
McMurray, John J.V.
Venue: Circulation Cardiovascular Imaging
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2010-07
Volume: 3
Issue: 4
Pages: 360-367
ISSN: 1941-9651 (ISSN-L)
1942-0080
DOI: 10.1161/circimaging.109.897439
OpenAlex: W2057038330
Cited by: 86
References: 29
Citations by year: 2025: 8 · 2024: 4 · 2023: 5 · 2022: 3 · 2021: 6 · 2020: 5 · 2019: 8 · 2018: 6 · 2017: 9 · 2016: 6 · 2015: 5 · 2014: 4 · 2013: 3 · 2012: 6
FWCI: 4.42
Type: journal article
Language: en
Open access: closed
Locations: Circulation Cardiovascular Imaging (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Fibrosis and Remodeling
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiomyopathy and Myosin Studies
Keywords: microvascular obstruction, left ventricular remodeling, left ventricular systolic dysfunction, acute myocardial infarction, infarct transmurality, infarct size, late gadolinium enhancement, risk stratification, coronary blood flow restoration
MeSH terms: Eplerenone, Mineralocorticoid Receptor Antagonists, Contrast Media, Double-Blind Method, Female, Humans, Image Processing, Computer-Assisted, Male, Microcirculation, Middle Aged, Myocardial Infarction, Placebos, Predictive Value of Tests, Spironolactone, Systole, Chi-Square Distribution, Linear Models, Ventricular Dysfunction, Left, Statistics, Nonparametric, Magnetic Resonance Angiography, Gadolinium DTPA, Ventricular Remodeling

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Microvascular obstruction remains a portent of adverse remodeling in optimally treated patients with left ventricular systolic dysfunction after acute myocardial infarction

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