Comments on: Major Prognostic Impact of Persistent Microvascular Obstruction as Assessed by Contrast-Enhanced Cardiac Magnetic Resonance in Reperfused Acute Myocardial Infarction http://www.thepreparedminds.com/archives/65 In the field of observation, chance favors the prepared minds. Sat, 04 Feb 2012 14:45:45 +0000 hourly 1 http://wordpress.org/?v=3.3 By: Phillip M. Young, MD http://www.thepreparedminds.com/archives/65/comment-page-1#comment-234 Phillip M. Young, MD Mon, 28 Sep 2009 03:43:19 +0000 http://www.thepreparedminds.com/?p=65#comment-234 Nice study with 184 patients with further data supporting the import of persistent microvascular obstruction in ischemic heart disease. Nice study with 184 patients with further data supporting the import of persistent microvascular obstruction in ischemic heart disease.

]]> By: Jacobo Kirsch, MD http://www.thepreparedminds.com/archives/65/comment-page-1#comment-203 Jacobo Kirsch, MD Mon, 14 Sep 2009 20:25:17 +0000 http://www.thepreparedminds.com/?p=65#comment-203 It has been shown that studies using non-specific agents (such as gadolinium) overestimate true infarct size when compared with ex-vivo staining methods. This overestimation has been reported to be between 9% and 12% in some papers. A recent article by Mather, et al. (PMID: <a href="http://www.ncbi.nlm.nih.gov/pubmed/19698105" rel="nofollow">19698105</a>) shows that MO during first-pass perfusion is smaller than in the delayed imaging sequences and propose that high resolution first-pass perfusion imaging may be the most accurate method to quantify MO. It has been shown that studies using non-specific agents (such as gadolinium) overestimate true infarct size when compared with ex-vivo staining methods. This overestimation has been reported to be between 9% and 12% in some papers.

A recent article by Mather, et al. (PMID: 19698105) shows that MO during first-pass perfusion is smaller than in the delayed imaging sequences and propose that high resolution first-pass perfusion imaging may be the most accurate method to quantify MO.

]]> By: Jacobo Kirsch, MD http://www.thepreparedminds.com/archives/65/comment-page-1#comment-140 Jacobo Kirsch, MD Sat, 08 Aug 2009 21:03:53 +0000 http://www.thepreparedminds.com/?p=65#comment-140 Very well designed study in a large number of patients (184) reveals that microvascular obstruction represents a strong independent predictor of major adverse cardiac effects. Prior reports had already reported this area of no-reflow as a good predictor for negative LV remodeling after an AMI. One limitation of the study, mentioned by the authors, is the lack of comparison with other exams to detect the no-reflow, such as myocardial blush grade by TIMI. However, another recent paper (PMID: <a href="http://www.ncbi.nlm.nih.gov/pubmed/19620437" rel="nofollow">19620437</a>) suggests the superior accuracy of MRI over MBG for the assessment of myocardial reperfusion injury. Very well designed study in a large number of patients (184) reveals that microvascular obstruction represents a strong independent predictor of major adverse cardiac effects.
Prior reports had already reported this area of no-reflow as a good predictor for negative LV remodeling after an AMI.
One limitation of the study, mentioned by the authors, is the lack of comparison with other exams to detect the no-reflow, such as myocardial blush grade by TIMI. However, another recent paper (PMID: 19620437) suggests the superior accuracy of MRI over MBG for the assessment of myocardial reperfusion injury.

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