Evolution of left ventricular function among subjects with ST-elevation myocardial infarction after percutaneous coronary intervention

Abstract

Background: Atrioventricular plane displacement (AVPD) reflects longitudinal left ventricular (LV) systolic function, and wall thickening (WT) regional radial LV function. The temporal evolution of these measures after STEMI with CMR has not been evaluated. We aimed to investigate how AVPD and WT are affected globally and regionally from the sub-acute to the chronic phase after ST-elevation myocardial infarction (STEMI). Methods: Healthy volunteers without cardiovascular disease and medication (controls, n = 20) and patients from the CHILL-MI study (NCT01379261) prospectively underwent magnetic resonance imaging (MRI) 2-6 days and 6 months after STEMI (n = 77). CHILL-MI randomized STEMI-patients to cooling therapy initiated before reperfusion or standard of care. AVPD was measured at six points in three long axis cine images and wall thickening in short axis cine images. Infarction was quantified using late gadolinium enhancement (LGE) and used to define infarct and remote segments.Results: There were no difference in AVPD either at acute or chronic phase (p = 0.90 and p = 0.40) or WT (p = 0.85 and p = 0.99) between patients randomized to cooling therapy and standard of care. Therefore, the results are presented for the pooled cohort. Global AVPD was decreased in both the sub-acute (12 ± 2 mm, p < 0.001) and the chronic phase (13 ± 2 mm, p < 0.001) compared to controls (15 ± 2 mm) with a partial recovery of AVPD (p < 0.001) in the chronic phase. Patients with left anterior descending (LAD) and right coronary artery (RCA) infarcts had decreased AVPD in the chronic phase in both infarcted and remote segments. Mean WT was decreased in patients with LAD infarction both in the sub-acute and the chronic phase in both infarcted and remote segments. The decrease in WT in patients with RCA and left circumflex (LCx) infarcts was more affected in the infarcted segments, especially in the chronic phase.

Anterior STEMI associated with decreased strain in remote cardiac myocardium

“…The results from RLS are in concordance to our findings of altered regional atrioventricular plane displacement [25]. The results that impaired regional function is poorly or moderately correlated to site infarction is also in concordance with Pahlm et al when studying wall motion in an animal setting pre and post infarction acutely [39].…”

“…Infarct extent was expressed as the proportion of endocardium involved in the infarction in relation to the total LV endocardial surface as previously described [ 32 ]. Remote myocardium was defined as absence of infarction assessed by LGE [ 25 , 33 ]. Infarct transmurality was expressed in percentage and calculated as the amount of infarcted myocardium divided by the myocardial volume, taken over the area of infarction.…”

“…We have previously shown that atrioventricular plane displacement is decreased in both the sub-acute and chronic phases after STEMI, resulting in a decreased longitudinal contribution to stroke volume in both phases [24][25][26]. While longitudinal contribution to stroke volume reflects the volumetric results of the contraction, longitudinal strain measures deformation at a myocardial level.…”

Differentiation Value of Left Atrial Dysfunction in Reperfused Chronic Myocardial Infarction

“…So MAPSE is of great importance to analyse LA strain. Many researchers argued that MAPSE has prognostic importance in the STEMI [34], stable patients with pulmonary regurgitation following therapy of tetralogy of Fallot(TOF) [35] and in acute Kawasaki disease [36]. We nd that anterior and posterior MAPSE are of great value to diagnose reperfused chronic myocardial infarction and are signi cantly related to reservoir LAEF.…”

Echocardiographic Evaluation of Systolic Left Ventricular function in Acute Myocardial Infarction in 1st Week of Hospitalization

“…11 It is secondary to a loss of contractile function of the infarct and ischaemic myocardium. 12 Over a period of 1 to 3 minutes, the regional disturbances of contraction progresses from dyssynchrony through hypokinesis (diminished motion) and akinesis (total lack of motion) to dyskinesia (paradoxical systolic expansion). 13 This loss of contractile function result in a decreased systolic ejection, increased end systolic volume, increased end diastolic volume and a secondary increase in diastolic filling pressure caused by the increase in ventricular volume.…”