Effect of intramyocardial haemorrhage on structural and functional echocardiographic parameters of myocardium after ST-segment elevation myocardial infarction with

Abstract

Aim. To analyze the effect of intramyocardial haemorrhage (IMH) on the structural and functional echocardiographic parameters of myocardium in patients with primary ST-segment elevation myocardial infarction (STEMI).Material and methods. The study included 60 patients with primary STEMI reperfused within 12 hours after symptom onset. On the second day after the event, all subjects underwent gadolinium-enhanced cardiac magnetic resonance imaging (MRI). IMH was visualized as T2-weighted hypointense areas. Subsequently, all patients underwent the standard echocardiography on the 7th day after MI.Results. IMH was revealed in 31 patients (51,6%). In 22 patients (70,9%), IMH was accompanied by microvascular obstruction (MVO). In the remaining 9 patients (29%), an isolated IMH phenomenon was visualized. Lower values of left ventricular ejection fraction (LVEF) and LV volume parameters were associated with a combination of MVO and IMH. At the same time, the indices of volumetric characteristics and LVEF in isolated IMH were the same as in the group without IMH and MVO. It was demonstrated that the IMH occupies 1% (1-3%) of the LV myocardium. Correlation analysis showed a moderate inverse correlation between the IMH area and LV contractile function: the larger the area, the lower the LVEF (R=-0,35; p=0,007).Conclusions. The analysis of the influence of different IMH phenotypes on the structural and functional echocardiographic parameters of myocardium in the short-term period after STEMI has shown that the combination of IMH with MVO and isolated IMH have different effects on LV contractile function. The combination of IMH with MVO is a predictor of a decrease in LVEF and increase of end-systolic volume (ESV), while an isolated IMH does not affect these parameters. Correlations between the IMH area and a decrease in LVEF, as well as an increase in ESV, have been demonstrated.

Keywords

• microvascular injury
• intramyocardial haemorrhage
• stemi
• myocardial infarction