Abstract
BackgroundWe sought to investigate the influence of the extent of myocardial injury on left ventricular (LV) systolic and diastolic function in patients after reperfused acute myocardial infarction (AMI).MethodsThirty-eight reperfused AMI patients underwent cardiac magnetic resonance (CMR) imaging after percutaneous coronary revascularization. The extent of myocardial edema and scarring were assessed by T2 weighted imaging and late gadolinium enhancement (LGE) imaging, respectively. Within a day of CMR, echocardiography was done. Using 2D speckle tracking analysis, LV longitudinal, circumferential strain, and twist were measured.ResultsExtent of LGE were significantly correlated with LV systolic functional indices such as ejection fraction (r = -0.57, p < 0.001), regional wall motion score index (r = 0.52, p = 0.001), and global longitudinal strain (r = 0.56, p < 0.001). The diastolic functional indices significantly correlated with age (r = -0.64, p < 0.001), LV twist (r = -0.39, p = 0.02), average non-infarcted myocardial circumferential strain (r = -0.52, p = 0.001), and LV end-diastolic wall stress index (r = -0.47, p = 0.003 with e’) but not or weakly with extent of LGE. In multivariate analysis, age and non-infarcted myocardial circumferential strain independently correlated with diastolic functional indices rather than extent of injury.ConclusionsIn patients with timely reperfused AMI, not only extent of myocardial injury but also age and non-infarcted myocardial function were more significantly related to LV chamber diastolic function.
Highlights
The hemodynamics on infarcted or non-infarcted myocardium is related to left ventricular (LV) remodeling after acute myocardial infarction (AMI) [1]
LV systolic and diastolic functional indicies Total late gadolinium enhancement (LGE) score, percent LGE and number of high signal intensity in T2 weighted images (T2WI)-cardiac magnetic resonance imaging (CMR) were used as an index of extent of LV myocardial infarction and extent of myocardial edema, respectively
Correlated with diastolic functional parameters. (Figure 2 and Table 3) Diastolic function was not significantly different between patients with microvascular obstruction (MVO) and without MVO. (11.4 ± 5.5 vs. 11.3 ± 3.6 p = 0.955 with E/e’; 6.5 ± 2.4 vs. 6.9 ± 3.0 cm/s, p = 0.634 with e’) Age did not correlate with LV systolic functional indices measured by LV ejection fraction (r = -0.075, p = 0.655), Regional wall motion score index (RWMSI) (r = -0.062, p = 0.713), global longitudinal strain (GLS) (r = 0.055, p = 0.743), or average global circumferential strain (GCS) (r = 0.182, p = 0.275) in this study
Summary
Study subjects Patients with AMI who underwent successful percutaneous coronary intervention (PCI) within 48 hours of chest pain were prospectively enrolled. The e’ and late diastolic velocities of the mitral annulus were measured from the apical 4-chamber view with a 2- to 5-mm sample volume placed at the septal corner of the mitral annulus. Speckle tracking echocardiography For the LV speckle tracking analysis, three parasternal short axis images (base, mid, and apical slices), apical four- and two-chamber view images were obtained using conventional gray scale echocardiography (Vivid 7 or E9; GE Medical Systems, Milwaukee, WI). LV systolic and diastolic functional indicies Total LGE score, percent LGE and number of high signal intensity in T2WI-CMR were used as an index of extent of LV myocardial infarction and extent of myocardial edema, respectively. For the analysis of predictive value of diastolic function included age, gender, presence of diabetes, hypertension, percent LGE, LV ejection fraction, LV mass index, M/V ratio, LVEDWS, Twist, and non-infarcted myocardial CS. All the analyses were done using SPSS (version 18.0, IBM, USA), and P values less than 0.05 were considered as significant
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