Skip to main content
SpringerLink
Log in

Intramyocardial dissecting hematoma in anterior wall ST elevation myocardial infarction: impact on left ventricular remodeling and prognosis

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

Intramyocardial dissecting hematoma is an uncommon complication of myocardial infarction potentially leading to cardiac rupture. The aim of the present study was to investigate coronary reperfusion results, left ventricular (LV) function recovery and remodeling and clinical outcomes in patients with anterior STEMI complicated by intramyocardial hematoma. We prospectively studied 87 patients (mean age 59 ± 10 years; 88% male) with anterior STEMI (42 with intramyocardial hematoma) in order to evaluate coronary reperfusion results, LV remodeling (≥15% increase in end-systolic volume) and clinical outcomes (cardiac death, non-fatal reinfarction, and hospitalization for congestive heart failure) at 24 months. Thrombolysis in myocardial infarction (TIMI) flow score and myocardial blush grade (MBG) were assessed both pre- and post-percutaneous coronary intervention (PCI) and speckle-tracking echocardiography was performed post PCI and at 6-month follow-up. Patients with hematoma had lower post-PCI TIMI score and MBG, higher heart rate, worse LV ejection fraction and longitudinal or rotational function than their counterparts. LV remodeling occurred in 33 (78.6%) patients with hematoma and 11 (24.4%) patients without (p < 0.001). Independent predictors of LV remodeling were heart rate (p = 0.018), MBG (p = 0.036) and presence of hematoma (p < 0.001). Hematoma (log-rank test, χ2 = 9.849; p = 0.002) and LV remodeling (log-rank test, χ2 = 13.770; p < 0.001) were associated to a higher rate of adverse events. Cox analysis identified LV remodeling as the only independent predictor of adverse events (hazard ratio = 3.912; 95% confidence interval, 1.429–10.714; p = 0.008). Intramyocardial dissecting hematoma complicating anterior STEMI is an independent determinant of LV remodeling and is associated to poor prognosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Pliam MB, Sternileb JJ (1993) Intramyocardial dissecting hematoma: an unusual form of subacute cardiac rupture. J Card Surg 8:628–637

    Article  CAS  PubMed  Google Scholar 

  2. Harpaz D, Kriwisky M, Cohen AJ, Medalion B, Rozenman Y (2001) Unusual form of cardiac rupture: sealed subacute left ventricular free wall rupture, evolving to intramyocardial dissecting hematoma and to pseudoaneurysm formation—a case report and review of the literature. J Am Soc Echocardiogr 14:219–227

    Article  CAS  PubMed  Google Scholar 

  3. Vargas-Barrón J, Romero-Cárdenas A, Roldán FJ et al (2005) Long-term follow-up of intramyocardial dissecting hematomas: complicating acute myocardial infarction. J Am Soc Echocardiogr 18(1422):e1–e6

    Google Scholar 

  4. Lunseth JH, Ruwaldt M (1956) Pathogenesis of cardiac rupture due to myocardial infarction. Dis Chest 30:499–507

    Article  CAS  PubMed  Google Scholar 

  5. Lewis AJ, Burchell HB, Titus JL (1969) Clinical and pathologic features of postinfarction cardiac rupture. Am J Cardiol 23:43–53

    Article  CAS  PubMed  Google Scholar 

  6. Oliva P, Hammill S, Edwards W (1993) Cardiac rupture, a clinically predictable complication of acute myocardial infarction: report of 70 cases with clinicopathologic correlations. J Am Coll Cardiol 22:720–726

    Article  CAS  PubMed  Google Scholar 

  7. Buckberg G, Mahajan A, Saleh S, Hoffman JI, Coghlan C (2008) Structure and function relationships of the helical ventricular myocardial band. J Thorac Cardiovasc Surg 136:578–589

    Article  PubMed  Google Scholar 

  8. Vargas-Barron J, Roldán FJ, Romero-Cárdenas et al (2009) Dissecting intramyocardial hematoma: clinical presentation, pathophysiology, outcomes and delineation by echocardiography. Echocardiography 26:254–261

    Article  PubMed  Google Scholar 

  9. Drozdz J, Kasprzak JD, Krzeminska-Pakula M (2002) Spontaneous closure (thrombosis) of the intramyocardial dissection: 40 month follow-up. J Am Soc Echocardiogr 15:1023–1024

    Article  PubMed  Google Scholar 

  10. Joyce E, Hoogslag GE, Leong DP et al (2014) Association between left ventricular global longitudinal strain and adverse left ventricular dilatation after ST–segment–elevation myocardial infarction. Circ Cardiovasc Imaging 7:74–81

    Article  PubMed  Google Scholar 

  11. Takeuchi M, Nishikage T, Nakai H, Kokumai M, Otani S, Lang RM (2007) The assessment of left ventricular twist in anterior wall myocardial infarction using two-dimensional speckle tracking imaging. J Am Soc Echocardiogr 20:36–44

    Article  PubMed  Google Scholar 

  12. Nucifora G, Ajmone Marsan N, Bertini M et al (2010) Reduced left ventricular torsion early after myocardial infarction is related to left ventricular remodeling. Circ Cardiovasc Imaging 3:433–442

    Article  PubMed  Google Scholar 

  13. Spinelli L, Morisco C, Assante di Panzillo E, Izzo R, Trimarco B (2013) Reverse left ventricular remodeling after acute myocardial infarction: the prognostic impact of left ventricular global torsion. Int J Cardiovasc Imaging 29:787–795

    Article  PubMed  Google Scholar 

  14. Dohi T, Maehara A, Brener SJ et al (2015) Utility of peak creatine kinase-MB measurements in predicting myocardial infarct size, left ventricular dysfunction, and outcome after first anterior wall acute myocardial infarction (from the INFUSE-AMI Trial). Am J Cardiol 115:563–570

    Article  CAS  PubMed  Google Scholar 

  15. The TIMI Study Group (1985) The thrombolysis in myocardial infarction (TIMI) trial. N Engl J Med 31:932–936

    Article  Google Scholar 

  16. Van’t Hof AWJ, Liem A, Suryapranata H, Hoorntje JC, de Boer MJ, Zijlstra F (1998) Angiographic assessment of myocardial reperfusion in patients treated with primary angioplasty for acute myocardial infarction: myocardial blush grade. Circulation 97:2302–2306

    Article  Google Scholar 

  17. Lang RM, Bierig M, Devereux RB et al (2005) Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18:1440–1463

    Article  PubMed  Google Scholar 

  18. Lancellotti P, Moura L, Pierard LA et al (2010) European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve disease). Eur J Echocardiogr 11:307–332

    Article  PubMed  Google Scholar 

  19. White HD, Norris RM, Brown MA, Brandt PW, Whitlock RM, Wild CJ (1987) Left ventricular end-systolic volume as the major determinant of survival after recovery from myocardial infarction. Circulation 76:44–51

    Article  CAS  PubMed  Google Scholar 

  20. Wang J, Khoury DS, Yue Y, Torre-Amione G, Nagueh SF (2007) Left ventricular untwisting rate by speckle tracking echocardiography. Circulation 116:2580–2586

    Article  PubMed  Google Scholar 

  21. Stöllberger C, Finsterer J, Waldenberger FR, Hainfellner JA, Ullrich R (2001) Intramyocardial hematoma mimicking abnormal left ventricular trabeculations. J Am Soc Echocardiogr 14:1030–1032

    Article  PubMed  Google Scholar 

  22. Ito H, Okamura A, Iwakura K et al (1996) Myocardial perfusion patterns related to thrombolysis in myocardial infarction perfusion grades after coronary angioplasty in patients with acute anterior wall myocardial infarction. Circulation 93:1993–1999

    Article  CAS  PubMed  Google Scholar 

  23. Reffelmann T, Kloner RA (2002) The “no reflow” phenomenon: basic science and clinical correlates. Heart 87:162–168

    Article  PubMed  PubMed Central  Google Scholar 

  24. Ikeda N, Yasu T, Kubo N et al (2004) Effect of reperfusion therapy on cardiac rupture after myocardial infarction in Japanese. Circ J 68:422–426

    Article  PubMed  Google Scholar 

  25. Hutchins KD, Skurnick J, Lavenhar M, Natarajan GA (2002) Cardiac rupture in acute myocardial infarction: a reassessment. Am J Forensic Med Pathol 23:78–82

    Article  PubMed  Google Scholar 

  26. Vargas-Barron J, Antunez-Montes O, Roldan FS, et al (2015) Myocardial rupture in acute myocardial infarction: mechanicistic explanation based on the ventricular myocardial band hypothesis. Rev Inves Clin 67:318–322

    Google Scholar 

  27. Sutton MGSJ, Sharpe N (2000) Left ventricular remodeling after myocardial infarction: pathophysiology and therapy. Circulation 101:2981–2988

    Article  CAS  PubMed  Google Scholar 

  28. Bolognese L, Neskovic AN, Parodi G et al (2002) Left ventricular remodeling after primary coronary angioplasty: patterns of left ventricular dilation and long-term prognostic implications. Circulation 106:2351–2357

    Article  PubMed  Google Scholar 

  29. Altiok E, Tiemann S, Becker M et al (2014) Myocardial deformation imaging by two-dimensional speckle-tracking echocardiography for prediction of global and segmental functional changes after acute myocardial infarction: a comparison with late gadolinium enhancement cardiac magnetic resonance. J Am Soc Echocardiogr 27:249–257

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy

    Letizia Spinelli, Eugenio Stabile, Giuseppe Giugliano, Carmine Morisco, Massimo Imbriaco, Giovanni Esposito & Bruno Trimarco

  2. Department of Translational Medical Sciences, Federico II University, Naples, Italy

    Caterina Anna Giudice & Mario Santoro

Authors
  1. Letizia Spinelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eugenio Stabile
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Giuseppe Giugliano
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Carmine Morisco
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Caterina Anna Giudice
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Massimo Imbriaco
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mario Santoro
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Giovanni Esposito
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Bruno Trimarco
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Letizia Spinelli.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interes.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Spinelli, L., Stabile, E., Giugliano, G. et al. Intramyocardial dissecting hematoma in anterior wall ST elevation myocardial infarction: impact on left ventricular remodeling and prognosis. Int J Cardiovasc Imaging 34, 201–210 (2018). https://doi.org/10.1007/s10554-017-1221-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-017-1221-0

Keywords

Search

Navigation