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Microvascular perfusion 1 week and 6 months after myocardial infarction by first-pass perfusion cardiovascular magnetic resonance imaging
  1. V Bodí1,
  2. J Sanchis1,
  3. M P López-Lereu2,
  4. J Núñez1,
  5. R Sanz3,
  6. P Palau1,
  7. C Gómez1,
  8. D Moratal3,
  9. F J Chorro1,
  10. À Llácer1
  1. 1Department of Cardiology, Hospital Clínico y Universitario de Valencia, Universidad de Valencia, Valencia, Spain
  2. 2Cardiovascular Magnetic Resonance Imaging Unit, ERESA, Valencia, Spain
  3. 3Universidad Politécnica, Valencia, Spain
  1. Correspondence to:
    V Bodí
    Department of Cardiology, Hospital Clínico y Universitario de Valencia, Blasco Ibáñez 17, 46010 Valencia, Spain; vicentbodi{at}hotmail.com

Abstract

Objective: To characterise the evolution of myocardial perfusion during the first 6 months after myocardial infarction by first-pass perfusion cardiovascular magnetic resonance imaging (CMR) and determine its significance.

Design: Prospective cohort design.

Setting: Single-centre study in a teaching hospital in Spain.

Patients: 40 patients with a first ST-elevation myocardial infarction, single-vessel disease and thrombolysis in myocardial infarction (TIMI) grade 3 flow (stent in 33 patients) underwent rest and low-dose dobutamine CMR 7 (SD 1) and 184 (SD 11) days after infarction. Microvascular perfusion was assessed at rest by visual assessment and quantitative analysis of first-pass perfusion CMR. Of the 640 segments, 290 segments subtended by the infarct-related artery (IRA) were focused on.

Results: Both 1 week and 6 months after infarction, segments with normal perfusion showed more wall thickening, contractile reserve and wall thickness, and less transmural necrosis, p <0.05 in all cases. Of 76 hypoperfused segments at the first week, 47 (62%) normalised perfusion at the sixth month. However, 42 segments (14% of the whole group) showed chronic abnormal perfusion; these segments showed worse CMR indices in the late phase (p<0.05 in all cases).

Conclusions: In patients with an open IRA, more than half of the segments with abnormal perfusion at the first week are normally perfused after six months. First-pass perfusion CMR shows that in a small percentage of segments, abnormal perfusion may become a chronic phenomenon—these areas have a more severe deterioration of systolic function, wall thickness, contractile reserve and the transmural extent of necrosis.

  • CMR, cardiovascular magnetic resonance imaging
  • IRA, infarct-related artery
  • TIMI, thrombolysis in myocardial infarction
  • True FISP, true fast imaging in steady-state precession

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Footnotes

  • Published Online First 27 June 2006

  • Funding: This study was supported by the Generalitat Valenciana (GRUPO0442) and by a grant from Guidant.

  • Competing interests: None.

  • Ethical approval: The local ethics committee approved the research protocol. Informed consent was obtained from all patients.

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