Comparison of the influence of acute transmural and nontransmural myocardial infarction on ventricular function

Abstract

In order to assess the relative impact on left and right ventricular function of nontransmural and transmural acute myocardial infarction (AMI), we performed radionuclide ventriculography in 86 patients (54 men and 32 women) within 16 hours after a first infarct. Nontransmural infarction was present in 19 patients (11 anterior and 8 inferior). Transmural infarction was found in 67 patients (30 anterior and 37 inferior). Left ventricular ejection fractions were higher (0.57 ± .014 vs 0.46 ± 0.14, p < 0.005) and left ventricular end-systolic volume lower (29 ± 11 vs 42 ± 20 ml/m 2, p = 0.013) in patients with nontransmural infarction compared to those with transmural infarction. Right ventricular ejection fraction also may have been different in the two groups (0.63 ± 0.15 vs 0.55 ± 0.13, p = 0.057). In patients with inferior infarction, left and right ventricular ejection fractions were similar in patients with nontransmural and transmural infarction (0.60 ± 0.09 vs 0.55 ± 0.10, p = 0.119 and 0.58 ± 0.14 vs 0.51 ± 12, p = 0.226). On the other hand, patients with anterior transmural infarction had lower left ventricular ejection fractions (0.36 ± 0.12 vs 0.54 ± 0.17, p = 0.003) but similar right ventricular ejection fractions (0.60 ± 0.13 vs 0.66 ± 0.14, p = 0.14) compared to those with nontransmural anterior infarction. In 29 additional patients with a history of previous infarction, no differences in any of the parameters studied were found between those with transmural and those with nontransmural infarcts. Thus, left ventricular function is better preserved in patients with a first nontransmural infarct compared to those with a first transmural anterior infarct. However, this difference is not seen in patients with a history of a previous infarction.