From the Guidelines
The peri-infarct pattern is characterized by a zone of injured but potentially salvageable heart tissue adjacent to the central area of dead tissue, and its identification is crucial for guiding reperfusion therapy decisions and risk stratification. According to the American Heart Association electrocardiography and arrhythmias committee, council on clinical cardiology, the term Peri-infarction block is recommended when, in the presence of an abnormal Q wave generated by a myocardial infarction in the inferior or lateral leads, the terminal portion of the QRS complex is wide and directed opposite to the Q wave (ie, a QR complex in the inferior or lateral leads) 1.
Key Features of Peri-infarct Pattern
- Characterized by a zone of injured but potentially salvageable heart tissue adjacent to the central area of dead tissue (infarct core)
- Appears as an area with edema (swelling) and inflammation on cardiac MRI
- Represents tissue at risk that could either recover or progress to permanent damage depending on treatment timing
- Often serves as a substrate for dangerous arrhythmias following a heart attack
Clinical Significance
- Identification of the peri-infarct pattern helps guide reperfusion therapy decisions and risk stratification
- Treatment focuses on early restoration of blood flow through procedures like percutaneous coronary intervention or thrombolytic therapy, followed by medications including antiplatelet agents, statins, beta-blockers, and ACE inhibitors to optimize outcomes and prevent further damage to the peri-infarct zone 1.
Diagnosis and Interpretation
- The term Peri-ischemic block is recommended when a transient increase in QRS duration accompanies the ST-segment deviation seen with acute injury 1
- The peri-infarct pattern can be identified on imaging studies, including cardiac MRI, which shows characteristic changes in the area surrounding the myocardial infarction.
From the Research
Peri-Infarct Pattern
- The peri-infarct area is a critical region in the study of ischemic stroke, as it is the area surrounding the infarct core that is potentially salvageable with timely treatment 2.
- Research has shown that pericyte-mediated tissue repair through PDGFRβ promotes peri-infarct astrogliosis, oligodendrogenesis, and functional recovery after acute ischemic stroke 2.
- The peri-infarct area is also relevant to the concept of the ischemic penumbra, which is the area of brain tissue that is at risk of infarction but has not yet undergone irreversible damage 3.
- Thrombolysis, including intravenous and intra-arterial approaches, is a key treatment strategy for acute ischemic stroke, and its effectiveness is influenced by the peri-infarct pattern and the presence of salvageable penumbra 4, 5, 6.
- New thrombolytic agents, such as tenecteplase, are being developed and studied for their potential to improve outcomes in patients with acute ischemic stroke, including those with large vessel occlusion 5, 6.
- The use of advanced neuroimaging and mobile stroke units may help to identify patients with salvageable penumbra and facilitate timely treatment, including thrombolysis, to improve outcomes in patients with acute ischemic stroke 6.