Recovery of regional and global left ventricular systolic function after acute myocardial infarction: a comparative study between emergency percutaneous coronary intervention and fibrinolytic therapy

Abstract

Objectives Quantitative assessment of the recovery of regional and global left ventricular systolic function after reperfusion in acute myocardial infarction. Background Left ventricular systolic function is an important predictor of the outcome after acute myocardial infarction. Patients and methods The study included 60 patients with first-time acute myocardial infarction: 30 were treated with fibrinolytic therapy (the pharmacological subgroup) and 30 with emergency percutaneous coronary intervention (the invasive subgroup). Evaluation was performed at 1 week and after 30 days by conventional echocardiography, tissue Doppler imaging, and two-dimensional strain (global longitudinal peak systolic strain). Results About 47% of the study population was considered as having a significant recovery in systolic function by 1 month (60% of the invasive subgroup and 40% of those who had fibrinolysis). Conventional echo parameters showed an insignificant difference from 1 week to 1 month as well as between the two subgroups. There was a significant improvement in the systolic wave by tissue Doppler from 5 ± 4 cm/s at 1 week to 7 ± 3 cm/s at 1 month, and it was higher in the invasive subgroup compared with the pharmacological subgroup (8 ± 2 vs. 5 ± 2 cm/s, P = 0.02). The global longitudinal peak systolic strain showed a significant improvement from −13.5 ± 7% at 1 week to −15 ± 8% at 1 month. It was better in the invasive group than in the pharmacological group at baseline (−15.2 ± 5 vs. −11.9 ± 4%, P = 0.04). At 1 month, the global longitudinal peak systolic strain improved to −12 ± 4 and −16 ± 3% in the pharmacological and the invasive subgroups, respectively ( P = 0.04). Conclusion The global longitudinal peak systolic strain and tissue Doppler parameters detected the recovery of left ventricular systolic function after myocardial infarction. Moreover, better recovery was reported in invasive reperfusion than in the pharmacological group.