CAD: Acute Coronary Syndromes

1356533 - Reperfusion hemorrhage compromises myocardial salvage

Friday, January 27, 2023

10:20 AM – 11:00 AM

Location: Pacific Jewel

Presenting Author(s)

TL

Ting Liu, PhD

professor
The First Hospital of China Medical University, China (People's Republic)

Primary Author(s)

TL

Ting Liu, PhD

professor
The First Hospital of China Medical University, China (People's Republic)

Co-Author(s)

AH

Andrew G. Howarth, MD, PhD

Clinical Co-director
Libin Cardiovascular Institute of Alberta, University of Calgary
Calgary, Alberta, Canada
Yinyin Chen, MD

Attending Radiologist
Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China
LOS ANGELES, California, China (People's Republic)
HY

Hsin-Jung Yang, PhD

Assistant Professor
Cedars-Sinai Medical Center
Los Angeles, California, United States
RT

Richard LQ. Tang, MD

Faculty
Indiana University School of Medicine, California, United States
DD

Damini Dey, PhD

doctor
Cedars-Sinai Medical Center, Los Angeles, California, USA, California, United States
Piotr J. Slomka, PhD

Director of Innovation in Imaging, Professor of Medicine and Cardiology
Cedars-Sinai
Los Angeles, California, United States
John C. Wood, MD, PhD

Professor
Children's Hospital Los Angeles
Los Angeles, California, United States
DB

Daniel S. Berman, MD

doctor
Cedars-Sinai Medical Center, Los Angeles, California, USA, United States
AK

Andreas Kumar, MD

doctor
Northern Ontario School of Medicine, Sudbury,Ontario, Canada
Sudbury, Ontario, Canada
Rohan Dharmakumar, PhD

Professor of Medicine, Radiology & Imaging Sciences, Anatomy, Cell Biology & Physiology
Krannert Cardiovascular Research Center, Indiana University School of Medicine
Indianapolis, Indiana, United States

Disclosure(s):

Piotr Slomka: No relevant disclosure to display

John C. Wood, MD, PhD: No relevant disclosure to display

Background: Reperfusion therapy for acute myocardial infarction (MI) is lifesaving. However, the benefit of reperfusion therapy can be paradoxically diminished by reperfusion injury, which can increase MI size. Hemorrhage is known to occur in reperfused MIs, but whether hemorrhage plays a role in reperfusion mediated MI expansion is not known.

Methods:

We studied cardiac troponin kinetics (cTn) of ST-segment elevation MI patients (n = 70) classified by cardiovascular magnetic resonance to be hemorrhagic (70%) or nonhemorrhagic following primary percutaneous coronary intervention. To isolate the effects of hemorrhage from ischemic burden, we performed controlled canine studies (n = 25), and serially followed both cTn and MI size with time-lapse imaging.

Results: CTn was not different before reperfusion; however, an increase in cTn following primary percutaneous coronary intervention peaked earlier (12 hours vs 24 hours; P < 0.05) and was significantly higher in patients with hemorrhage (P < 0.01). In hemorrhagic animals, reperfusion led to rapid expansion of myocardial necrosis culminating in epicardial involvement, which was not present in nonhemorrhagic cases (P < 0.001). MI size and salvage were not different at 1 hour postreperfusion in animals with and without hemorrhage (P = 0.65). However, within 72 hours of reperfusion, a 4-fold greater loss in salvageable myocardium was evident in hemorrhagic MIs (P < 0.001). This paralleled observations in patients with larger MIs occurring in hemorrhagic cases (P < 0.01).

Conclusion:

Myocardial hemorrhage is a determinant of MI size. It drives MI expansion after reperfusion and compromises myocardial salvage. This introduces a clinical role of hemorrhage in acute care management, risk assessment, and future therapeutics.