Non-uniform recovery of left ventricular transmural mechanics in ST-segment elevation myocardial infarction

Cardiovascular Ultrasound

Research

Mackram F Eleid¹  Haruhiko Abe¹  Partho P Sengupta¹  Susan Wilansky¹  Nisha Bhatia¹  F David Fortuin¹  Scipione Carerj¹  Giuseppe Caracciolo¹ 

[1] Division of Cardiovascular Diseases, Mayo Clinic Arizona 13400 East Shea Blvd, 85259, Scottsdale, AZ, USA;

关键词: Percutaneous Coronary Intervention;    Acute Myocardial Infarction;    Primary Percutaneous Coronary Intervention;    Speckle Tracking;    Wall Motion Score Index;   

DOI  :  10.1186/1476-7120-8-31

 received in 2010-06-09, accepted in 2010-08-03,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundAfter a transient ischemic episode, the subendocardial region is more severely injured than outer subepicardial layers and may regain a proportionately greater degree of mechanical function in the longitudinal direction. We sought to explore left ventricular (LV) transmural mechanics in patients with ST-segment elevation myocardial infarction (STEMI) for determining the mechanism underlying recovery of global LV function after primary percutaneous coronary intervention (PCI).MethodsA total of 42 patients (62 ± 11 years old, 71% male) with a first STEMI underwent serial assessments of LV longitudinal, circumferential and radial strains (LS, CS and RS) by selective tracking of subendocardial and subepicardial regions within 48 hours and a median of 5 months after PCI. LV mechanical parameters were compared with sixteen age and gender matched normal controls.ResultsIn comparison with controls, endocardial and epicardial LS were markedly attenuated at 48 hours following PCI (P < 0.001). An improvement in LV ejection fraction (EF > 5%) following PCI was seen in 24 (57%) patients and was associated with improvement in endocardial and epicardial LS (P < 0.001 and P = 0.003, respectively) and endocardial CS (P = 0.01). Radial strain and wall motion score index, however, remained persistently abnormal. The change in endocardial LS (OR 1.2, 95% CI 1.03 to 1.42, P = 0.01) and the change in epicardial LS (OR 1.2, 95% 1.03 to 1.46, P = 0.02) were significantly associated with the improvement in LVEF, independent of the location of STEMI and the presence of underlying multivessel disease.ConclusionsIn patients with STEMI treated by PCI, the recovery of LV subendocardial shortening strain seen in the longitudinal direction underlies the improvement in LV global function despite persistent abnormalities in radial mechanics and wall motion score index.

【 授权许可】

Unknown   
© Caracciolo et al; licensee BioMed Central Ltd. 2010. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0)which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.