Citation, DOI and article data
Intramyocardial hemorrhage is referred to as the extravasation of erythrocytes and/or blood products into the myocardium.
Intramyocardial hemorrhage occurs in 35-50% of the patients with successful coronary revascularization of ST-elevation myocardial infarction 1-4.
Intramyocardial hemorrhage is characterized by erythrocytes and blood products within the myocardium or rather within the myocardial extracellular space. In the setting of myocardial infarction and reperfusion, it is strongly associated with the occurrence of late microvascular obstruction (MVO) 1-4.
The immediate cause is vascular endothelial damage secondary to the following 1-6
- reperfusion injury
- cardiac trauma
Intramyocardial hemorrhage has been diagnosed in the setting of a hypointense zone surrounded by myocardial edema in T2-weighted and/or STIR images 3. Hemoglobin and its degradation products are known for their paramagnetic effect and thus influence MR relaxation times 1.
- T2/STIR: hypointense
- T2* mapping: two cut off values: T2* < 20 [ms] or 2 standard deviations below the mean 3
- T2 mapping: decreased T2 [ms] *
- T1 mapping: decreased T1 [ms] *
- IRGRE/PSIR: hypointense zone within an infarct zone of late gadolinium enhancement, indistinguishable from microvascular obstruction
Treatment and prognosis
Intramyocardial hemorrhage is a source of residual myocardial iron, which is thought to cause prolonged inflammation and thus adverse remodeling, associated with a poorer prognosis or major adverse cardiovascular events (MACE).
- 1. Calvieri C, Masselli G, Monti R, Spreca M, Gualdi G, Fedele F. Intramyocardial Hemorrhage: An Enigma for Cardiac MRI? BioMed Research International. 2015;2015:1-8. doi:10.1155/2015/859073
- 2. Bulluck H, Dharmakumar R, Arai A, Berry C, Hausenloy D. Cardiovascular Magnetic Resonance in Acute ST-Segment–Elevation Myocardial Infarction. Circulation. 2018;137(18):1949-1964. doi:10.1161/circulationaha.117.030693
- 3. Ibanez B, Aletras A, Arai A et al. Cardiac MRI Endpoints in Myocardial Infarction Experimental And Clinical Trials. J Am Coll Cardiol. 2019;74(2):238-256. doi:10.1016/j.jacc.2019.05.024
- 4. Hamirani Y, Wong A, Kramer C, Salerno M. Effect of Microvascular Obstruction and Intramyocardial Hemorrhage by CMR on LV Remodeling and Outcomes After Myocardial Infarction. JACC Cardiovasc Imaging. 2014;7(9):940-952. doi:10.1016/j.jcmg.2014.06.012
- 5. Burrell A, Hare J, Francis P et al. Impact of Cardiac Magnetic Resonance Imaging. Circ J. 2014;79(1):216-217. doi:10.1253/circj.cj-14-0626
- 6. Kaneda K, Yamamura H, Yamamoto T, Matsumoto K, Ehara S, Mizobata Y. Efficacy of Cardiac Magnetic Resonance for the Qualitative Diagnosis of Blunt Cardiac Injury. Acute Medicine & Surgery. 2015;3(1):53-56. doi:10.1002/ams2.122