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Myocardial hemorrhage after STEMI predicts HF, CV death

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In a cohort of patients with STEMI, myocardial hemorrhage increased risk for death or HF and was associated with adverse remodeling, according to new findings.

Researchers performed a prospective cohort study of patients with reperfused STEMI who underwent T2*-weighted cardiac MRI at 2 days (n = 286) and 6 months (n = 228) after their event.

In 30 of the participants, the researchers also performed a serial imaging substudy, in which images were taken at 4 to 12 hours, 2 days, 10 days and 6 to 7 months.

Colin Berry, FRCP, and colleagues investigated the relationship between myocardial hemorrhage, defined as a hypointense infarct core with a T2* value less than 20 ms, and CV death and HF events after discharge. They presented their findings at the British Cardiovascular Conference and published them in Circulation: Cardiovascular Imaging.

Colin Berry

There were 245 patients with T2* data that could be evaluated (mean age, 58 years; 76% men).

After multivariable adjustment, myocardial hemorrhage was associated with adverse remodeling (OR = 2.64; 95% CI, 1.07-6.49), defined as a rise of 20% or more in left ventricular end-diastolic volume at 6 months, according to the researchers.

Among the cohort, 4% experienced CV death or had a HF event after discharge. After multivariable adjustment, including for baseline LV end-diastolic volume, myocardial hemorrhage was associated with the composite outcome (HR = 5.89; 95% CI, 1.25-27.74), but microvascular obstruction was not, the researchers found.

In the serial imaging substudy, myocardial hemorrhage occurred in 23% of patients at 4 to 12 hours, 43% at 2 days, 33% at 10 days and 13% at 7 months, Berry, from the British Heart Foundation Glasgow Cardiovascular Research Center, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland, and Golden Jubilee National Hospital, Clydebank, Scotland, and colleagues found.

Amount of hemorrhage (median, 7% of LV mass; interquartile range, 4.9-7.5) was highest on day 2 (P < .001), whereas microvascular obstruction was reduced over time after reperfusion, according to the researchers.

“This research has provided us with a new understanding of heart muscle injury and how it develops,” Berry said in a press release. “We can now focus our research on developing new treatments to reduce the level of this injury following [MI]. The study has also presented a new way of identifying those at a higher risk [for HF] before the condition develops. This knowledge can be used to identify those most in need to interventions and monitoring earlier.” – by Erik Swain

References:

Berry C, et al. Hot Topics. Presented at: British Cardiovascular Society Conference; June 6-8, 2016; Manchester, England.

Carrick D, et al. Circ Cardiovasc Imaging. 2016;doi:10.1161/CIRCIMAGING.115.004148.

Disclosure: The study was supported in part by a nonfinancial research agreement with Siemens Healthcare. Berry reports no relevant financial disclosures.