Late microvascular obstruction after acute myocardial infarction: Relation with cardiac and inflammatory markers

• Published in: International journal of cardiology 2012-06, Vol.157 (3), p.391-396
• Main Authors: Mayr, Agnes, Klug, Gert, Schocke, Michael, Trieb, Thomas, Mair, Johannes, Pedarnig, Kathrin, Pachinger, Otmar, Jaschke, Werner, Metzler, Bernhard
• Format: Article
• Language: English
• Subjects: Acute myocardial infarction; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Biomarkers - metabolism; C-Reactive Protein - physiology; Cardiac magnetic resonance imaging; Cardiac marker; Cardiology. Vascular system; Cardiovascular; Cohort Studies; Coronary heart disease; Female; Heart; Humans; Inflammation Mediators - physiology; Male; Medical sciences; Microvascular obstruction; Microvessels - metabolism; Microvessels - pathology; Microvessels - physiopathology; Middle Aged; Myocardial Infarction - complications; Myocardial Infarction - pathology; Myocardial Infarction - physiopathology; Myocarditis. Cardiomyopathies; Time Factors; Troponin T - physiology
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2010.12.090

Abstract Objectives We sought to assess the relation of late microvascular obstruction (l-MVO) size as quantified by cardiac magnetic resonance (CMR) imaging with cardiac and inflammatory marker concentrations after acute myocardial infarction (AMI). Methods CMR was performed in 118 consecutive patients within 8 days after successful interventional reperfused first acute ST-elevation AMI. Infarct volumes and l-MVO sizes were calculated from late enhancement (LE) sequences and functional parameters were determined from short-axis cine MR sequences. Creatine kinase (CK) and cardiac troponin T (cTnT), high-sensitivity C-reactive protein (hs-CRP) as well as lactate dehydrogenase (LD) concentrations were determined serially from day 1 to day 4 after symptom onset. Results L-MVO was detected in 66/118 patients (55.9%) and comprised 18.2 ± 10% of infarct size and 4.7 ± 3% of left ventricle myocardial mass. Each single-point, peak and cumulative release concentration of cTnT (r = 0.44 to 0.73, p < 0.0001), CK (r = 0.21 to 0.76, p < 0.0001), LD (r = 0.36 to 0.82, all p < 0.0001) as well as hs-CRP single-point values as assessed from day 1 to day 4 and its peak and cumulative release concentrations (r = 0.24 to 0.49, p < 0.003) significantly correlated with l-MVO size. Receiver operating curve (ROC) analysis indicated a cut-off value of 4.7 μg/l cTnT to best identify the presence of l-MVO (area under the curve (AUC) 0.904; 95% CI: 0.85–0.95; p < 0.0001). Conclusion L-MVO sizes significantly correlate with cardiac and inflammatory marker concentrations as determined early after AMI. cTnT concentration of > 4.7 μg/l could help to identify patients in whom l-MVO is present.