Evolution of regional performance after an acute anterior myocardial infarction in humans using magnetic resonance...

Regional remodelling after a left ventricular myocardial infarction is the first step in a cascade that may lead to heart failure and death. To understand better the mechanisms underlying this process, it is important to study not only the evolution in local deformation parameters but also the corresponding loading conditions. Using magnetic resonance (MR) myocardial tagging, we measured the regional contribution to ejection (regional ejection fraction) and loading (systolic blood pressure x radius of curvature (mean of short and long axes)/wall thickness) in 32 regions throughout the left ventricle (LV) in patients 1 week (1W) and 3 months (3M) after a first anterior infarction. Using positron emission tomography (PET), the LV was divided into infarct, adjacent and remote regions. In the remote regions the average deformation decreased between 1W and 3M (from 59.3 +/- 5.6 to 57.9 +/- 6.7 %, P < 0.05) due to an increase in loading conditions only (from 730 +/- 290 to 837 +/- 299 mmHg, P < 0.05). In the adjacent myocardium, no change in function was observed (49.0 +/- 10.8 to 49.0 +/- 6.5 %, P = n.s.), although loading increased (806 +/- 297 to 978 +/- 287 mmHg, P < 0.05). In the infarct region only, an increase in deformation was seen (30.7 +/- 14.2 to 37 +/- 6.9 %, P < 0.05), together with a higher loading level (1229 +/- 422 to 1466 +/- 284 mmHg, P < 0.05), which indicates a true improvement in function. The fact that MR tagging can identify both regional deformation and loading permits us to differentiate between changes due to alterations in regional loading conditions and true changes in function. After an acute myocardial infarction (MI), an improvement can be observed in the deformation-loading relation in the adjacent and infarct regions, but the improvement is mainly in the infarct region. Using this technique, types of intervention leading to even more functional gain could be evaluated.