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BMC Cardiovascular Disorders

, 16:198

Coronary artery disease


BackgroundInfarct heterogeneity, as assessed by determination of the peri-infarct zone PIZ by cardiac magnetic resonance imaging, has been shown to be an independent predictor for the development of cardiac arrhythmias and mortality post myocardial infarction MI. The temporal evolution of the PIZ post MI is currently unknown. Thus, the main objective of our study was to describe the temporal evolution of the PIZ over a 6 month time period in contemporarily managed ST elevation myocardial infarction STEMI patients. Further, given the poor prognosis associated with microvascular obstruction MVO post STEMI, we sought to compare the temporal evolution of the PIZ in patients with and without MVO. We hypothesized that patients with MVO would show a relative persistence of PIZ over time when compared to those without MVO.

MethodsTwenty-one patients post primary percutaneous coronary intervention were enrolled and treated with evidence based therapy. Each patient had three cardiac MRI scans at 48 h, 3 weeks and 6 months post infarction. Repeated Measures Analysis of Variance ANOVA was used to assess the evolution of core infarct size and peri-infarct zone size across the three time frames.

ResultsThe patients in this study were predominantly male, with ~40 % LAD territory infarction and a mean LVEF of 46 ± 7 %. Core infarct size and PIZ size both decreased significantly across the three time frames. The presence of microvascular obstruction MVO, a known adverse prognostic factor, influenced PIZ size. Both patients with and without MVO had a significant reduction in core infarct size over time. Patients with MVO did not have a significant change in PIZ size over time 11.9 ± 6.8 %, 12.2 ± 7.5 %, 10.7 ± 6.6 % p = 0.77. In contrast, non-MVO patients did have a significant decrease in PIZ size over time 7.0 ± 5.5 %, 7.1 ± 6.5 %, 2.7 ± 2.6 %, p = 0.01.

ConclusionsPeri-infarct zone size, like core infarct size, varies depending upon the timing of measurement. Patients with MVO displayed a persistence of the PIZ over time.

KeywordsST elevation myocardial infarction STEMI Cardiac magnetic resonance imaging Infarct heterogeneity Gray zone-Peri-infarct zone AbbreviationsAMIAcute myocardial infarction

ANOVAAnalysis of variance

CISCore infarct size

CMRCardiac magnetic resonance

GZGray zone

ICDImplantable cardioverter defibrillator

MVOMicrovascular obstruction

PCIPercutaneous coronary intervention

PIZPeri-infarct zone

STEMIST elevation myocardial Infarction

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