752 Left ventricular function improvement and left ventricular remodeling in patients with acute myocardial infarction treated with PTCA

Abstract

Background: Early perfusion recovery after AMI decreases mortality, limits the infarct size, reduces change of LV geometry, and allows to maintain its global function. At present there are no published data on relationship between remodeling, left ventricular function improvement and assessment of myocardial integrity with use of the MCE (myocardial contrast echocardiography). The goal of the study is the comparition of predictive value of rt MCE for predicting LV function improvement and occurrence of remodeling and assessing its timing. Methods: 42 patients (29 male, 56 yrs), with first anterior wall myocardial infarction (onset 6 hous), treated with PTCA who on the second day underwent rt MCE with use of Opison given by bolus of dose 0,3-0,5 ml. After assessing left ventricular ejection fraction (+/-LVEF), myocardial perfusion (MP) in dysfunctional segments was assessed (2=homogenous, 1=reduced, 0=absent), and perfusion score index (PSI) was a mean of results of MP for dysfunctional segments (RA). Regional and global left ventricular function were again assessed after 1 and 6 months after the infarction, LVEF increase bigger then 5% manifested recovery function systolic, and EDV increase bigger then 20% in long term follow up determined remodeling. Based upon rt MCE result microvascular integrity of the was preserved if > 50% dysfunctional segments demonstrated homogenous contrast effect. Results: In 1 month and 6 month observation correlation between PSI and LVEF change was significant (r=0,6129, p<0,007), (r=0,7465, p<0,001), and sensitivity, specificity, PPV, NPV accuracy for predicting LV function improvement were 69%, 73,3%, 81,8%,57,8%, 70,7%, after 1 month, and 71,4%, 83,3%, 90,9%, 55,6%, 75% after 6 months. Instead there was no correlation between PSI and remodeling in 1 month follow up. It occurred in 6 month follow up (r=0,5120, p<O,01), and sensitivity, specificity, PPV, NPV, accuracy for predicting of remodeling 44%, 31,3%, 50%, 26,3%, 39% after 1 month, and 69,5%, 64,7%, 72,7%, 67,5% after 6 months.