Editorial for “Detection of Intramyocardial Iron in Patients Following ST‐Elevation Myocardial Infarction Using Diffusion Tensor Imaging”
Abstract
Despite enormous progress in research and clinical care, myocardial infarction (MI) remains the most frequent cause of premature death worldwide according to the World Health Organization. An in-depth understanding of tissue pathology is key to the development of future therapies. MI is primarily defined by cardiomyocyte necrosis. However, the cardiac microvasculature can also be damaged by ischemic injury: Kloner et al first observed that myocardial blood flow could not be completely restored after severe ischemic myocardial injury. Microvascular obstruction was identified as the culprit leading to “no-reflow” in reperfused MI. Bresnahan et al, followed by others, identified microvascular disruption as the most severe form of microvascular damage, with microvascular necrosis leading to intramyocardial hemorrhage after reperfusion. With the advancement of noninvasive imaging techniques over the last decades, primarily using cardiovascular magnetic resonance, it became possible to study those tissue changes in vivo, both, in experimental models an in patients. Clinical imaging studies identified hemorrhage to occur frequently in reperfused ST-elevation myocardial infarction (STEMI) patients, usually between 40–70% of patients are affected. Multiple clinical studies have associated hemorrhage with adverse outcome, independent of infarct size. Translational studies have also started to shed further insight on hemorrhagic MI. A recent study showed that hemorrhage is a key driver…
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