Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Docent Tomas Bjerner, Department of Surgical Sciences, Uppsala University, Sweden
- Second opponent: Professor Stein Ørn, Faculty of Health Sciences, University of Stavanger
- Third member and chair of the evaluation committee: Associate Professor Anne Negård, Faculty of Medicine, University of Oslo
Chair of the Defence
Professor II Mona Kristiansen Beyer, Faculty of Medicine, University of Oslo
Principal Supervisor
MD Pavel Hoffman, Oslo University Hospital
Summary
Patients with ST-elevation myocardial infarction (STEMI) treated successfully with primary percutaneous coronary intervention (PCI) or with thrombolysis and PCI have generally a good prognosis. Initial patency of the infarct related artery is regarded as successful treatment. However, this does not always result in sufficient perfusion of the microcirculation. While some patients have normal left ventricular function, others develop heart failure. Evaluation of myocardial perfusion may predict the long-term function of the left ventricle.
The aim of the thesis was to evaluate two imaging methods of myocardial perfusion with angiography and cardiac magnetic resonance (CMR) imaging in STEMI patients, successfully treated with thrombolysis and PCI or with primary PCI.
Myocardial perfusion was recorded during angiography immediately after PCI. CMR first-pass perfusion imaging was performed few days after the PCI to track contrast enhancement of the myocardium. The maximum contrast enhancement (MCE) was assessed to describe the relative increase in signal intensity in different areas of the myocardium.
After successful PCI, reduced angiographic myocardial perfusion was associated with reduced left ventricle ejection fraction and increased infarct size, evaluated with CMR after three to four months. Reduced MCE in the infarcted myocardium was associated with reduced left ventricle function after four months.
CMR early after the infarction showed that MCE in the infarcted area was lower than in the remote area. At four months this difference diminished. Patients with low MCE early after the infarction still had decreased MCE in both the infarcted and remote area after four months.
In conclusion, this thesis shows that reduced myocardial perfusion evaluated with angiography and CMR were associated with long-term CMR functional and anatomical findings. Moreover, CMR microvascular perfusion also detected changes in non-infarcted areas of the left ventricle.
Additional information
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<title of article> (link to article about the thesis)