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Published on: December 11, 2016
Myocardial wall thickness predicts recovery of contractile function after primary coronary intervention for acute
Elena Biagini1, Tjebbe W Galema, Arend F L Schinkel
1Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
Insights
End-diastolic wall thickness (EDWT) effectively predicts left ventricular functional recovery after percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). Thicker walls (≥11 mm) with perfusion show the highest recovery rates.
Area of Science:
- Cardiology
- Echocardiography
- Interventional Cardiology
Background:
- Regional contractile function recovery varies post-PCI for acute myocardial infarction (AMI).
- Predicting functional recovery aids clinical decision-making in AMI patients.
Purpose of the Study:
- To determine if end-diastolic wall thickness (EDWT) predicts regional left ventricular contractile function recovery after PCI.
- To assess the role of EDWT in conjunction with myocardial perfusion for predicting functional recovery.
Main Methods:
- Left ventricular contrast echocardiography was used in 40 AMI patients.
- Wall thickness, function, and myocardial perfusion were measured immediately after and two months post-PCI.
- Analysis focused on 175 dysfunctional segments within the infarct territory.
Main Results:
- Segments with EDWT ≥11 mm (72 segments) showed significantly higher perfusion rates (99%) compared to those with EDWT <11 mm (61%).
- Functional recovery at two months was 92% for segments with EDWT ≥11 mm versus 34% for segments with EDWT <11 mm.
- Perfusion status further stratified recovery: high for EDWT ≥11 mm with perfusion, intermediate for EDWT <11 mm with perfusion, and very low for EDWT <11 mm without perfusion.
Conclusions:
- EDWT is a simple, valuable predictor of functional recovery post-revascularization.
- Combining EDWT and perfusion provides a robust assessment of recovery potential.
- Patients with thinner walls (<11 mm) and absent perfusion have a poor prognosis for functional recovery.
Objectives:
We sought to determine whether end-diastolic wall thickness (EDWT) can predict recovery of regional left ventricular contractile function after percutaneous coronary intervention (PCI).
Background:
Regional contractile function does not recover in all patients after PCI for acute myocardial infarction (AMI). Prediction of functional recovery after AMI may help in clinical decision making.
Methods:
Forty consecutive patients with AMI were studied with left ventricular contrast echocardiography for accurate wall thickness and function measurement and myocardial perfusion immediately after and two months following PCI.
Results:
Out of 640 segments, 175 (27%) dysfunctional segments in the infarct territory were analyzed for EDWT, wall function, and perfusion. One hundred and three (59%) dysfunctional segments presented with an EDWT <11 mm and 72 (41%) presented with an EDWT > or =11 mm. Perfusion (partial or complete) was present in 63 segments with an EDWT <11 mm (61%) and 71 segments with an EDWT > or =11 mm (99%) (p < 0.001). At two months' follow-up, 66 of 72 segments with an EDWT > or =11 mm (92%) improved, whereas only 35 of 103 of the dysfunctional segments with an EDWT <11 mm (34%) improved (p < 0.0001).
Conclusions:
Wall thickness is an easy parameter to predict recovery of function after revascularization. Moreover, combining EDWT and perfusion, segments with an EDWT > or =11 mm, and presence of perfusion have the highest chance of recovery; segments with an EDWT <11 mm and perfusion have an intermediate chance of recovery. In segments with an EDWT <11 mm and no perfusion, chances of recovery are very low.
