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Wall motion changes in myocardial infarction in relation to the time elapsed from symptoms until revascularization
Ildikó Rácz1, László Fülöp, Rudolf Kolozsvári
1Institute of Cardiology and Heart Surgery, University of Debrecen Clinical Center; Debrecen-Hungary. iracz73@gmail.com.
Insights
Wall motion abnormalities in ST-segment elevation myocardial infarction (STEMI) vary initially but improve with shorter ischemic times. Early intervention is key for better left ventricular function recovery after primary PCI.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Interventional Cardiology
Background:
- Acute ST-segment elevation myocardial infarction (STEMI) causes wall motion abnormalities.
- The extent of these abnormalities and their recovery post-recanalization are influenced by coronary occlusion.
- Understanding these dynamics is crucial for optimizing treatment strategies.
Purpose of the Study:
- To investigate the relationship between ischemic time and left ventricular wall motion abnormalities in STEMI patients.
- To assess the impact of ischemic time on functional recovery after primary percutaneous coronary intervention (PCI).
Main Methods:
- Evaluated 57 STEMI patients with one-artery occlusion treated with primary PCI.
- Used coronary angiography and echocardiography to assess the area at risk and wall motion abnormalities.
- Compared these findings with elapsed time from symptom onset and at 3-month follow-up.
Main Results:
- No correlation between initial wall motion index and symptom onset time.
- Improvement in wall motion abnormalities at follow-up was dependent on ischemic time (r=-0.29, p<0.03).
- Early STEMI subgroup showed improved ejection fraction; late subgroup had increased ventricular diameters.
Conclusions:
- Initial wall motion abnormalities in STEMI show variability unrelated to symptom onset time.
- Follow-up echocardiography demonstrates that functional recovery is significantly influenced by ischemic time.
- Shorter ischemic times are associated with better wall motion improvement post-PCI.
Objective:
Wall motion abnormalities during acute ST-segment elevation myocardial infarction (STEMI) and the improvement after recanalization depend on the conditions of the coronary occlusion.
Methods:
Fifty-seven patients with first-ever STEMI due to one-artery occlusion, treated with primary PCI, were evaluated. Area at risk and left ventricular wall motion abnormalities were localized with coronary angiography and echocardiography and then compared in relation to the time elapsed from the onset of symptoms at the time of infarction and at 3 months. Left ventricular diameters and ejection fractions were evaluated in relation to the ischemic time.
Results:
Three hundred forty-one affected left ventricular segments were detected with angiography, while echocardiography showed 206 segments with motion abnormality. No correlation was found between the regional wall motion index in the area at risk and the time elapsed from the beginning of symptoms. However, the improvement in wall motion abnormalities at the follow-up was dependent on the ischemic time (r=-0.29, p<0.03). The early subgroup showed significant improvement in left ventricular ejection fraction at follow-up (p=0.03), whereas in the late subgroup, a significant increase in left ventricle diameters was observed.
Conclusion:
Our results first demonstrate in humans that in the early hours from the occlusion of the coronary artery, the extent and severity of the wall motion abnormalities inside the area at risk show large variability without relation to the elapsed time since the onset of symptoms. On the other hand, the results of follow-up echocardiography proved that the wall motion improvement was highly dependent on the ischemic time.
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