Longitudinal left ventricular function is globally depressed within a week of STEMI

Abstract

Sixty percent of stroke volume (SV) is generated by atrioventricular plane displacement (AVPD) in a healthy left ventricle (LV). The aims were to determine the effect of ST-elevation myocardial infarction (STEMI) on AVPD and contribution of AVPD to SV and to study the relationship between AVPD and infarct size (IS) and location. Patients from CHILL-MI and MITOCARE studies with cardiovascular magnetic resonance within a week of STEMI (n = 177, 59 AE 11 years) and healthy controls (n = 20, 62 AE 11 years) were included. Left ventricular volumes were quantified in short-axis images. AVPD was measured in six locations in long-axis images. Longitudinal contribution to SV was calculated as AVPD multiplied by the short-axis epicardial area. Patients (IS 17 AE 10% of LV) had decreased ejection fraction (48 AE 8%) compared to controls (60 AE 5%, P<0Á001). Global AVPD was decreased in patients (11 AE 2 mm versus 15 AE 2 mm in controls, P<0Á001) and this held true for both infarcted and remote segments. AVPD contribution to SV was lower in patients (58 AE 9%) than in controls (64 AE 8%) (P<0Á001). There was a weak negative correlation between IS and AVPD (r 2 =0Á06) but no differences in global AVPD linked to infarct location. Decrease in global and regional AVPD occur even in remote myocardium within 1 week of STEMI. Global AVPD decrease is independent of MI location, and MI size has only minor effect. Longitudinal pumping is slightly lower compared to controls but remains to be the main component to SV even after STEMI. These results highlight the difficulty in determining infarct location and size from longitudinal measures of LV function.

Mitral annular plane systolic excursion by cardiac MR is an easy tool for optimized prognosis assessment in ST-elevation myocardial infarction

“…Romano et al used death as a primary endpoint, which might serve as an explanation why their reported cut-off for lateral MAPSE (9 mm) is equal as we found for septal MAPSE. However, Pahlm et al reported a decrease in global and regional MAPSE in infarcted as well as remote myocardium, supporting our thesis that septal MAPSE provides prognostic information regardless of infarct localization [32]. Based on the significantly higher predictive value of septal MAPSE compared with lateral and average MAPSE in our population as well as on the independency of MAPSE decrease from infarct location, we consider the exclusive measurement of septal MAPSE to be reasonable.…”

Decreased atrioventricular plane displacement after acute myocardial infarction yields a concomitant decrease in stroke volume

“…The results in our study are in line with previous clinical studies reporting that AVPD decreases after myocardial infarction (1,6,25,37). This experimental study shows how the SV and related cardiac parameters change as a result of decreased AVPD after AMI, which is not possible to investigate in clinical studies, where a baseline examination is practically difficult.…”

“…All results combined suggest that AVPD is likely to be globally reduced after AMI. This has also recently been reported by Pahlm et al in patients (n ϭ 177) within a week after ST-elevation myocardial infarction (37).…”

“…Heart failure (HF) is a major global health burden, and an estimated 6.5 million adults are suffering from this condition in the United States alone (3). One of the most common causes of HF is acute myocardial infarction (AMI), and patients with HF due to AMI have decreased longitudinal ventricular function (2,37). The most common type of AMI is an infarction from an acute or rapidly aggravated obstruction of a coronary artery (41,49).…”

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

“…Global longitudinal LV shortening measured as global longitudinal strain (GLS) can be used to detect MI [6], and has prognostic value superior to ejection fraction (EF) [7]. Longitudinal LV systolic shortening is also reflected by the atrioventricular plane displacement (AVPD) [8] which has been shown to be the main contributor to LV stroke volume in healthy individuals [9] and in patients with STEMI, both in the sub-acute [10] and the chronic phases [11]. GLS and AVPD differs as GLS quantifies myocardial shortening in the long-axis direction and the latter measure the summed effect of this contraction on the AV-plane.…”