Іntramyocardial hemorrhage in patients with ST elevation myocardial infarction: prevalence, association with endothelial function, and significance for the development of postinfarction left ventricular dilatation
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Abstract
The aim – to determine the prevalence and major risk factors of intramyocardial hemorrhage (IMH) in timely revascularized patients with ST elevation myocardial infarction (STEMI), and to evaluate its importance for the development of postinfarction left ventricular (LV) dilatation.
Materials and methods. We examined 24 patients with acute first anterior STEMI, who were admitted in the first six (on average 2.8±1.4) hours from symptoms development. The presence of IMH was assessed by cardiovascular magnetic resonance examination 3-4 days after primary percutaneous coronary intervention (pPCI). Echocardiography was performed during the first 24 hours and day 90 after acute MI. LV dilatation was defined as at least 20 % increase of end-diastolic volume at 90 days. Endothelium-dependent flow-mediated brachial artery dilatation (FMD) was measured using high-resolution ultrasound at admission.
Results and discussion. More than a third (37.5 %) of patients with anterior STEMI who underwent pPCI had signs of IMH. Hemorrhagic transformation of acute myocardial infarction was more often manifested in patients who were prescribed enoxaparin at the prehospital stage (RR = 3.75; 95 % CI 1.47–9.56) and less often in patients with multivessel (≥ 3) coronary artery disease (RR = 0.21; 95 % CI 0.03–1.00). There is a tendency to a more frequent detection of IMH in patients with endothelial dysfunction. Impaired reactive hyperemia (FMD ≤ 4.9 %) was associated with IMH development (RR 3.5; 95 % CI 0.9–13.5). The patients with IMH had a greater extent of myocardial damage according to CK-MB AUC and LGE at MRI and a more frequent development of postinfarction LV dilatation (RR 5.0; 95 % CI 1.3–19.7). The addition of intravenous quercetin started before pPCI to the standard basic treatment of acute myocardial infarction was associated with a significant decrease in the probability of hemorrhagic transformation (RR 0.21; 95 % CI 0.03–1.00).
Conclusions. Pre-hospital administration of enoxaparin and endothelial dysfunction were the main predictors of IMH after pPCI in STEMI patients, whereas it was detected much less frequently in patients with multivessel (≥ 3) coronary artery disease. The presence of IMG has been associated with a greater extent of necrotized myocardium and more frequent development of postinfarction dilatation and dysfunction of the LV.
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References
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