Recovery Of Left Ventricular Wall Motion Research Articles

Left ventricular myocardial function assessed by three-dimensional speckle tracking echocardiography in Takotsubo cardiomyopathy.

We aimed to investigate left ventricular (LV) functional recovery in Takotsubo cardiomyopathy (TC) using three-dimensional (3D) speckle tracking echocardiography. Twenty-one patients with TC who underwent routine and 3D echocardiography as well as electrocardiography were enrolled. 3D images were analyzed to measure 3D radial strain and area tracking (area change of each LV segment). Postsystolic shortening (PSS) or thickening (PST) was defined as a further shortening or thickening occurred after the end-systole. 3D echocardiography and ECG were repeated at 4weeks and 6months later. Mean age was 70.9±11.1years, and 18 (86%) patients were female. All patients presented classical type of TC with apical ballooning. LV ejection fraction (EF) improved from 49.9±7.2 to 64.9±6.0% (P<.001) at 4weeks without segmental wall-motion abnormality. However, PSS or PST still existed in 43% of LV segments, and electrocardiographic abnormality was also observed in 51% at 4weeks and disappeared at 6months. Mean 3D radial strain decreased from baseline to 6months at base (36.1±19.6 vs 28.0±12.6%, P=.04), whereas it increased at mid (16.2±7.2 vs 28.7±9.1%, P=.03) and the apex (8.0±4.4 vs 21.2±7.9%, P<.001). Mean area tracking increased from baseline to 6months at mid and apex (-28.5±9.5 vs -44.5±9.6%, P<.001 for mid, and -24.2±13.0 vs -42.9±16.8%, P=.002 for the apex), while it did not change at base (-37.0±8.9 vs -41.9±9.6%, P=NS). Patients with TC show abnormal wall motion during acute phase. Even after LV wall-motion recovery, subtle abnormalities of regional LV function appear to persist at 4weeks followed by normalization at 6months.

Acute phase myocardial edema was related to recovery process of regional left ventricular wall motion abnormality in takotsubo cardiomyopathy

Background: Takotsubo cardiomyopathy (TC, stress cardiomyopathy, apical ballooning syndrome) is characterized by transient reversible systolic dysfunction of the apical and/or mid segments of the left ventricular (LV). However, the recovery process of LV systolic dysfunction is not known in detail. Methods: We retrospectively evaluated 40 consecutive patients (38 women, 2 men) who were diagnosed as TC in our hospital between June 2007 and October 2012. Main outcome was complete recovery of LV wall motion. Clinical characteristics of early recovery group (n=16; LV wall motion recovered completely within 7 days) and late recovery group (n=24; abnormal LV wall motion remained after 7 days) were compared. Then, we recorded cardiovascular magnetic resonance imaging (CMR) within three days after hospitalization in 27 of 40 patients to evaluate an acute phase histological change of the diseased myocardium. Results: A stressful trigger could be identified in 26 patients (mental: 10, physical: 16). Average LV ejection fraction (LVEF) evaluated by left ventriculography was 50%. There were no statistically significant differences about age, coronary risk factor, laboratory data, QTc in electrocardiogram, and LVEF between two groups. Regional myocardial edema (high intensity in T2-weighted images of CMR) could be identified in 5 of 9 patients (56%) in early recovery group and 18 of 18 patients (100%) in late recovery group (P<0.05). ![Figure][1] Figure 1. Regional myocardial edema on CMR Conclusions: Acute phase myocardial edema detected by CMR images may relate to recovery process of LV wall motion abnormality in TC patients. [1]: pending:yes

Ultrasonic Strain Versus Coronary Flow Velocity Pattern for Predicting Regional Wall Motion Recovery After Primary Coronary Intervention for Acute Myocardial Infarction

Strain Doppler echocardiography can detect regional myocardial dysfunction after acute myocardial infarction (AMI). The aim of this study was to assess the utility of strain in predicting regional wall motion recovery after AMI compared with the coronary flow velocity pattern. Thirty-three patients with anterior AMIs undergoing successful coronary intervention were included. Longitudinal myocardial strain and coronary flow velocity were measured <24 hours after coronary intervention. Regional wall motion was analyzed by the anterior wall motion score index (A-WMSI). End-systolic strain (r = 0.72, P < .0001), peak strain (r = 0.58, P < .005), and corrected time to peak strain (the time delay from end-systolic to peak strain divided by the RR interval) (r = 0.80, P < .0001) showed good correlations with A-WMSI at 4 weeks. Similarly, diastolic deceleration time was significantly correlated with A-WMSI at 4 weeks (r = 0.69, P < .0001). The diagnostic value in predicting wall motion recovery was compared using a receiver operating characteristic curve. The area under the curve of corrected time to peak strain tended to be larger than that of diastolic deceleration time (0.94 +/- 0.04 vs 0.86 +/- 0.06). Strain can predict left ventricular wall motion recovery in patients with AMIs after coronary intervention comparable with predictions using the coronary flow velocity pattern.

Preserved microvascular function is related to late recovery of left ventricular wall motion in patients with acute myocardial infarction

Purpose: The aim of this study is to elucidate the relationship between the extent of microvascular impairment assessed by Nitrogen-13 positron emission tomography (N-PET) and the improvement in left ventricular (LV) wall motion after acute myocardial infarction (AMI). Methods: We prospectively studied 12 patients (7 men, mean 69 yrs) with first AMI who were successfully reperfused. All patients had single vessel disease and showed no restenosis in infarct-related artery during observation periods. Myocardial flow reserve (MFR) was calculated using N-PET performed at 2 weeks. The extent of regional LV wall motion (RWM; SD/chords) in infarct-related segments (IRS) was assessed by contrast left ventriculography after 1 month and 6 months. Results: Of the total 84 segments, 33 were IRS. In the 33 infarct-related segments, 21 showed severe microvascular impairment (Group S; MFR < 2.0) and 11 showed mild microvascular impairment (Group M; MFR > 2.0). In Group M, the RWM significantly improved from 1month to 6months (−2.83 ± 1.49 to −1.49 ± 1.46, p = 0.03), while it did not improve in group M. The MFR within IRS was more closely correlated with the RWM at 6 month (r = 0.67, p < 0.0001) than with that at 1 month (r = 0.40, p < 0.0001). Conclusion: Data indicated that late recovery of LV wall motion depends on the extent of preserved microvascular function after successful reperfusion in AMI patients.

696 Value of first-pass and delayed contrast-enhancement by magnetic resonance imaging for the prediction of left ventricular wall motion recovery after reperfused acute myocardial infarction

696 Value of first-pass and delayed contrast-enhancement by magnetic resonance imaging for the prediction of left ventricular wall motion recovery after reperfused acute myocardial infarction

110 Value of low mechanical index real time myocardial contrast echocardiography for the prediction of left ventricular wall motion recovery after reperfused acute myocardial infarction

110 Value of low mechanical index real time myocardial contrast echocardiography for the prediction of left ventricular wall motion recovery after reperfused acute myocardial infarction

Prediction of left ventricular wall motion recovery after acute myocardial infarction by Tl-201 gated SPECT: Incremental value of integrated contractile reserve assessment

Background. This investigation tested the application of low-dose dobutamine (LDD) gated single photon emission computed tomography (SPECT) with thallium 201 for myocardial viability detection early after acute myocardial infarction (AMI). Methods and Results. Thirty-two hemodynamically stable post-AMI patients (aged 55 ± 5 years [mean ± SEM]; 20 men) who were exhibiting regional left ventricular dysfunction underwent stress-redistribution Tl-201 scanning within 4 to 8 days, followed by 2 additional gated SPECT acquisitions after Tl-201 reinjection, at rest and during LDD. A visual 5-point score was computed for segmental radiotracer uptake (0, normal; 4, absent) and a 4-point score for left ventricular wall motion (1, normal; 4, dyskinesis). Predominant viable myocardium in dyssynergic regions was predicted by a mean Tl-201 uptake score of 2 or less or ischemic area of 30% or greater. These indices showed a significant association with wall motion improvement in follow-up echocardiographic studies (overall accuracy = 0.69, sensitivity = 0.93, and specificity = 0.50). Regarding the response to LDD stimulus, an increase in mean wall motion score of 30% or greater was predictive of predominant viable myocardium. Contractile reserve assessment yielded a significant increment in the predictive accuracy for function recovery (overall accuracy = 0.84, sensitivity = 0.71, and specificity = 0.94). Conclusions. Evaluation of contractile reserve by means of LDD gated SPECT with Tl-201 is safely feasible early after AMI, with incremental value over perfusion assessment alone for myocardial viability detection. (J Nucl Cardiol 2002;9:294-303.)

7.34 Myocardial contractile reserve assessment by gated SPECT thallium-201 improves prediction of left ventricular wall motion recovery after myocardium infarction provided by thallium-201 uptake

7.34 Myocardial contractile reserve assessment by gated SPECT thallium-201 improves prediction of left ventricular wall motion recovery after myocardium infarction provided by thallium-201 uptake

Coronary flow velocity immediately after primary coronary stenting as a predictor of ventricular wall motion recovery in acute myocardial infarction

OBJECTIVESThe purpose of this study was to examine the relationship between the pattern of coronary blood flow velocity immediately after successful primary stenting and the recovery of left ventricular (LV) wall motion in patients with acute myocardial infarction (AMI).BACKGROUNDIt is difficult to predict the recovery of LV wall motion immediately after direct angioplasty in AMI. Recent reports indicate that dysfunctional coronary microcirculation is an important determinant of prognosis for AMI patients after successful reperfusion.METHODSWe measured left anterior descending coronary flow velocity variables using a Doppler guide wire immediately after successful primary stenting in 31 patients with their first anterior AMI. The patients were divided into two groups: those with and those without early systolic reverse flow (ESRF). Changes in LV regional wall motion (RWM) and ejection fraction (EF) at admission and at discharge were compared between the two groups. Coronary flow velocity variables immediately after primary stenting were compared with changes in left ventriculographic indexes.RESULTSThe change in RWM was significantly greater in the non-ESRF group than it was in the ESRF group (0.9 ± 0.7 vs. −0.1 ± 0.3 standard deviation/chord, respectively, p < 0.001). The change in EF was also significantly greater in the non-ESRF group than it was in the ESRF group (10 ± 10 vs. 1 ± 6%, respectively, p < 0.05). In the non-ESRF group (diastolic to systolic velocity ratio [DSVR] <3.0), the DSVR correlated positively with the change in RWM (r = 0.60, p < 0.005, n = 24) and the change in EF (r = 0.52, p < 0.01).CONCLUSIONSThe coronary flow velocity pattern measured immediately after successful primary stenting is predictive of the recovery of regional and global LV function in patients with AMI.