Background. About one third of patients with TIMI 3 after reperfusion have evidence
of microvascular obstruction (MO) which represents an independent predictor of myocardial
wall rupture. This explains all efforts made to prevent MO. Magnetic resonance imaging
(MRI) has proved to be particularly useful in detecting MO. The aim of this study was to evaluate
with MRI if different fibrinolytic regimens in acute myocardial infarction display different effects
on left ventricle (LV) volumes and ejection fraction (EF), as well as on myocardial infarct size
(MIsz) and MO.
Methods. Twenty male patients, mean age 58 years, affected by acute myocardial infarction, ten anterior and ten inferior, were treated with: full dose reteplase in ten, and half dose reteplase plus full dose abciximab (R+Abcx) in the other ten patients. In the fourth day after hospital admission, MRI STIR T2 images were used to quantify MIsz, while 2dflash cineloops were used after the injection of gadolinium, to quantify LV volumes, EF and to detect MO.
Results. LV EF was higher in R+Abcx 51±10 than in reteplase 41±8. MIsz was similar in both treatment groups: however a close relationship was present between MIsz and EF in the reteplase group indicating that the greater the MIsz the lower the EF. In R+Abcx this relationship was no longer present, suggesting a protective effect of the drug on microcirculation. In fact extensive MO was present in 25% of all cases, 80% of which in the reteplase group while only 20% in R+Abcx.
Conclusion. R+Abcx prevents MO: compared to traditional fibrinolytic therapy it allows better LV function and most likely improved long term survival. (Heart International 2006; 2: 54-65)
Magnetic resonance, Myocardial infarction, Microvascular obstruction
Antonello Zoni, MD, Heart Department, University Hospital of Parma, Via Gramsci, 14, 43100 Parma – Italy, firstname.lastname@example.org
Share this Article
Related Content In Imaging
The Quantification of Total Coronary Atheroma Burden – A Major Step Forward
Heart International. 2020;14(2):73-5 DOI: https://doi.org/10.17925/HI.2020.14.2.73
More than half of acute coronary syndromes (ACS) occur in subjects with no significant coronary stenosis.1 In view of the number of patients dying each year from a heart attack, the question of identifying these patients is of primary importance. A large body of evidence currently exists, indicating that total coronary atheroma burden (TOCAB) – the […]
Left main Stenosis Stenting Normalizes Wall Shear Stress of Ascending Aorta in Bicuspid Aortic Valve
Heart International. 2020;14(2):121-2 DOI: https://doi.org/10.17925/HI.2020.14.2.121
Bicuspid aortic valve (BAV) represents the most common congenital cardiac anomaly, with a prevalence ranging between 1% and 2% in the general population.1 BAV is known to be associated with dilation and dissection of the ascending aorta, and the significantly higher shear forces seem to have a pivotal role on the development of such complications.2 Nowadays, patients […]
Computed Tomography-Based Patients’ Specific Biomechanical and Fluid Dynamic Study of Anomalous Coronary Arteries with Origin from the Opposite Sinus and Intramural Course
Heart International. 2020;14(2):105-11 DOI: https://doi.org/10.17925/HI.2020.14.2.105
Anomalous coronary arteries originating from the opposite sinus of Valsalva (ACAOS) is one of the most clinically relevant abnormalities among the wide spectrum of coronary artery anomalies.1 Sudden cardiac death has been related to myocardial bridges, ectopic origin of the pulmonary artery, a single coronary artery and ACAOS with an intramural course (ACAOS-IM), especially in young […]
Journal articles and more to your inbox
Get the latest clinical insights from touchCARDIOSign me up!