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Adjunctive thrombus aspiration (TA) during primary percutaneous coronary intervention improves myocardial perfusion and survival; however, the effect of effective thrombus retrieval remains unclear. We evaluated whether macroscopic-positive TA in patients with ST-segment elevation myocardial infarction would reduce the infarct size (IS) and microvascular obstruction (MVO), as assessed by contrast-enhanced magnetic resonance imaging. A total of 88 patients with ST-segment elevation myocardial infarction were prospectively recruited and assigned to the TA-positive group (n = 38) or TA-negative group (n = 50) according to whether macroscopic aspirate thrombus was visible to the naked eye. The primary end points were the extent of early and late MVO as assessed by contrast-enhanced magnetic resonance imaging performed during in-hospital stay and IS evaluated in the acute phase and at 6 months of follow-up. The incidence of early and late MVO and IS in the acute phase was lower in the TA-positive group than in the TA-negative group (early MVO 3.8 ± 1.1% vs 7.6 ± 2.1%, respectively, p = 0.003; late MVO 2.1 ± 0.9% vs 5.4 ± 2.9%, p = 0.006; and IS 14.9 ± 8.7% vs 28.2 ± 15.8%, p = 0.004). At the 6-month contrast-enhanced magnetic resonance imaging study, the final IS was significantly lower in the TA-positive group (12.0 ± 8.3% vs 22.3 ± 14.3%, respectively) than in the TA-negative group (p = 0.002). After multivariate adjustment, macroscopic-positive TA represented an independent predictor of final IS (odds ratio 0.34, 95% confidence interval 0.03 to 0.71, p = 0.01). In conclusion, effective macroscopic thrombus retrieval before stenting during percutaneous coronary intervention for ST-segment elevation myocardial infarction is associated with an improvement in myocardial reperfusion, as documented by a clear reduction in the MVO extent and IS.

Endothelial colony-forming cells (ECFCs) are known to increase after acute myocardial infarction (AMI). We examined whether the presence of ECFCs is associated with preserved microvascular integrity in the myocardium at risk by reducing microvascular obstruction (MVO). We enrolled 88 patients with a first ST elevation AMI. ECFC colonies and circulating progenitor cells were characterized at admission. MVO was evaluated at 5 days and infarct size at 5 days and at 6-month follow-up by magnetic resonance imaging. ECFC colonies were detected in 40 patients (ECFC(pos) patients). At 5 days, MVO was of greater magnitude in ECFC(neg) versus ECFC(pos) patients (7.7 ± 5.3 vs. 3.2 ± 5%, p = 0.0002). At 6 months, in ECFC(pos) patients, there was a greater reduction in infarct size (-32.4 ± 33 vs. -12.8 ± 24%; p = 0.003) and a significant improvement in left ventricular (LV) volumes and ejection fraction. Level of circulating CD34+/VEGF-R2+ cells was correlated with the number of ECFC colonies (r = 0.54, p 0.001) and relative change in infarct size (r = 0.71, p 0.0001). The results showed that the presence of ECFC colonies is associated with reduced MVO after AMI, leading to reduced infarct size and less LV remodelling and can be considered a marker of preserved microvascular integrity in AMI patients.

Background Right ventricular (RV) function is a major prognostic factor in patients (pts) with operated tetralogy of Fallot (TOF). We compared the results of RV speckle tracking (two-dimensional [2D] strain) with those of magnetic resonance imaging (MRI) in this setting. Methods At transthoracic echocardiogram (echo), RV fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE), velocity of S-wave at tricuspid annulus with tissue Doppler, and 2D strain (longitudinal maximal systolic strain) were recorded. Their results were compared to RV indexed end-diastolic volume (EDV), indexed end-systolic volume (ESV), and RV ejection fraction (EF) at MRI. Results Twenty-two pts (16 M) aged 11–62 years (mean 23.2 ± 10.8) were included. Parameters of RV systolic function were as follows: RVFAC = 40 ± 10%, TAPSE = 18 ± 4 mm, S-wave = 10 ± 0.2 cm/sec, and RV EF at MRI = 43 ± 11%. Global RV systolic strain was −15.5 ± 4.2%, free wall strain was −15.1 ± 6.3%, and septal strain was −15.8 ± 3.8% on average for the whole group. Echo indexed RV end-diastolic area correlated with EDV at MRI (r = 0.73), as well as echo indexed RV end-systolic area and ESV at MRI (r = 0.71). Global RV 2D strain correlated well with RV EF at MRI: r = 0.68; P

Backgroundhromboaspiration (TA) during primary percutaneous intervention (PPCI) is effective in opening the infarct-related artery in patients with ST-segment elevation myocardial infarction (STEMI), leading to better reperfusion and improved outcome. However, the effect of positive macroscopic efficiency of TA remains unknown. We aimed to evaluate the impact of positive thrombus retrieval during PPCI with manual TA on infarct size (IS) and microvascular obstruction (MVO) as assessed by contrast-enhanced magnetic resonance imaging (CE-MRI) in a subset of patients with STEMI.MethodsInclusion criteria were patients aged

Thromboaspiration (TA) during primary percutaneous intervention (PPCI) is effective in opening the infarct-related artery in patients with ST-segment elevation myocardial infarction (STEMI), leading to better reperfusion and improved outcome. However, the effect of positive macroscopic efficiency of

Summary Background Acute coronary syndrome (ACS) with normal coronary angiography is a frequent clinical situation with an uncertain prognosis. Cardiac magnetic resonance imaging (CMRI) is a powerful tool for differential diagnosis between myocardial infarction (MI), acute myocarditis and Tako-tsubo cardiomyopathy (TTC). Data are sparse regarding the evolution of patients presenting an ACS with normal coronary arteries and normal CMRI. Aims To evaluate the evolution of patients presenting an ACS with normal coronary arteries and normal CMRI, with a 1-year follow-up. Methods Eighty-seven consecutive patients (mean age, 53 years; 40.2% men) presenting an ACS with troponin elevation and normal coronary arteries by angiography were prospectively included. All patients underwent CMRI at 3-Tesla. Adverse events were recorded with 1-year follow-up. Results A likely aetiology for the acute clinical presentation was established by CMRI in 63.2% of patients (22.7% MI, 26.4% acute myocarditis, 11.5% TTC). During follow-up, one patient in the MI group had a stroke (1.2%). In the myocarditis group, there was one initial cardiogenic shock, one episode of congestive heart failure (1.2%) and nine patients had recurrent chest pain without troponin elevation (10.3%). Two TTC group patients initially presented with cardiogenic shock (2.4%); there were no other adverse events in this group during follow-up. In the remaining 36.7% patients, no clear diagnosis could be identified by CMRI, and no adverse events occurred during follow-up. Conclusion CMRI is a useful tool for the management of ACS presenting with normal coronary angiography, as it helps to ascertain the diagnosis and adapt treatment in a large proportion of cases. Nonetheless, patients with no abnormalities identified by CMRI have an excellent evolution.

BackgroundMicrovascular obstruction (MVO) at the acute phase of myocardial infarction (MI) is associated with greater myocardial damage, left ventricular (LV) impairment and higher mortality. We compared the impact of early and late microvascular obstruction (MVO) as assessed by 3-T cardiac magnetic resonance imaging (MRI) at the acute phase of MI on LV remodeling at 6 months.MethodsWe included 51 consecutive patients (pts) with no previous history of cardiovascular disease, and presenting for first MI with or without ST elevation. Infarct size and extent of no-reflow were evaluated by 3-T MRI during acute phase by early and late hyperenhancement imaging at 3 and 15min after gadolinium injection. Extent of no-reflow at 3 minutes (early MVO) and 15 minutes (late MVO) was measured. Follow-up MRI was performed at 6 months. Systolic and diastolic LV volumes, as well as LV ejection fraction and infarct size were compared at baseline and 6 months.ResultsIncidence of early MVO was 56% vs 43% for late MVO. There was a significant difference in extent of no-reflow between early and late MVO (7.8±4% vs 5.4±4%, p

International audience; The purpose of this study was to assess the quality of 3-T magnetic resonance (MR) imaging of the skin, to describe skin anatomy at 3 T and to discuss future prospects of skin MRI. A 7-cm single-element surface receiver coil was developed for our 3-T MRI system. Thin sections were obtained with a three-dimensional FIESTA acquisition sequence and a spin-echo T1-weighted sequence (SET1). Prospective analysis was performed twice by two radiologists independently. Thirty-six healthy volunteers were included and underwent MRI on the face and the calf. Image quality was assessed regarding visibility of skin layers and quantification of artefacts. High field strength MR enables imaging of the skin with a high spatial in-plane resolution (87-180 microm), the total examination lasting 15-20 min. Image quality was excellent for the calf (mean SET1 quality = 96%) with a high intra- and interobserver correlation (SET1 kappa coefficient concerning visibility of epidermis, dermis and hypodermis > or = 0.84). Motion artefacts resulted in a small loss of quality and reproducibility for the face. In conclusion, 3-T MR allows high spatial resolution imaging of the skin and can potentially provide an accurate noninvasive means of analysing the skin.

The purpose of this study was to evaluate the CT findings that can help to differentiate small-bowel obstruction (SBO) due to adhesive bands from SBO caused by matted adhesions.CT scans of 67 consecutive patients with adhesive SBO caused by either surgically confirmed adhesive bands or matted adhesions were analyzed. CT findings were compared between the two groups with regard to simple obstruction patterns (single abrupt transition zone, beak sign, "fat notch" sign), patterns of closed-loop obstruction (two adjacent beaks, C-shaped bowel, radial distribution of mesenteric vessels), the location of the obstruction in the abdominal cavity, and the presence of a whirl sign and a "small-bowel feces" sign. Statistical analyses were performed using the Fisher's exact test.Closed-loop patterns and a whirl sign were seen only in cases of SBO from adhesive bands. Compared with SBO cases from matted adhesions, significantly more SBO cases that were due to adhesive bands showed a beak sign (p = 0.0001) and fat notch sign (p = 0.0001). The small-bowel feces sign was more frequently seen in cases of SBO from matted adhesions (p = 0.014). Bowel ischemia and bowel necrosis were more frequent findings with adhesive bands than with matted adhesions (p = 0.011 and p = 0.049, respectively). The location in the pelvis of the adhesive structure (p = 0.039) and a higher rate of accidental bowel perforation (p = 0.031) were associated with matted adhesions.CT is useful for differentiating SBO caused by adhesive bands from SBO due to matted adhesions.

The purpose of this study was to prospectively evaluate the safety of cardiac magnetic resonance (CMR) imaging at 3 T performed early (less than 14 days) after bare metal or drug-eluting coronary stent implantation in patients with acute myocardial infarction (AMI). Seventy-two consecutive patients with AMI treated by percutaneous revascularisation with a stent underwent CMR examination with a median delay of 6 days. Patients were followed-up for major adverse cardiac events, during hospitalisation and at 6 months. After CMR imaging, no acute stent thrombosis, death or repeated AMI were recorded at 6-month follow-up. Two symptomatic in-stent restenoses and two silent in-stent restenoses were recorded, at a mean delay of 106 days. In our population, we found a target revascularisation rate of 5.6%. This is consistent with the 6-month event rates after coronary artery stent (CAS) placement for AMI, evaluated by several studies. This preliminary clinical study supports the safety of 3-T CMR imaging performed early after coronary stent placement.

Aims Acute coronary syndrome (ACS) with normal coronary angiography is a frequent clinical situation with an uncertain prognosis. Cardiac magnetic resonance imaging (CMRI) is a powerful tool for differential diagnosis between myocardial infarction (MI), acute myocarditis and Tako-tsubo cardiomyopathy (TTC). However, CMRI can remain uninformative in many patients who have no detectable coronary lesion. Data are sparse regarding the prognosis of patients presenting an ACS with normal coronary arteries on CMRI. Methods Seventy-nine consecutive patients (mean age 53 years, 39.2% male) presenting an ACS with tropinin elevation and normal coronary angiography were prospectively included. All patients underwent CMRI at 3-Tesla within 3 weeks of initial presentation. Adverse events were recorded with a follow-up of 6 months. Results An identifiable basis for ACS was established by CMRI in 69.6% of patients (27.8% MI, 29.1% acute myocarditis, 12.7% TTC). Only troponin level was significantly different between patients with normal vs abnormal CMRI (3.48 ± 4.3 vs 11.86 ± 11.99 mg/L, respectively, p = 0.0028). During the follow-up, 1 patient in the MI group suffered stroke (1.26%). In the myocarditis group, there was 1 episode of congestive heart failure (1.26%) and 7 patients had recurrent chest pain without troponin elevation (8.6%). Two patients in the TTC group initially presented with cardiogenic shock (2.53%), but there were no adverse events in this group during follow-up. In the remaining 30.2% patients, no clear diagnosis could be identified by CMRI, and no adverse events occurred during follow-up. Conclusion CMRI is a useful tool for the management of ACS presenting with normal coronary angiography, as it helps to ascertain diagnosis and to adapt treatment in a large proportion of cases. Nonetheless, patients with no anomalies identified by CMRI have an excellent prognosis, without need for specific treatment.