Decreased atrioventricular plane displacement after acute myocardial infarction yields a concomitant decrease in
J Berg1, R Jablonowski1, D Nordlund1
1Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Clinical Physiology, Lund, Sweden.
Insights
Acute myocardial infarction (AMI) reduces stroke volume (SV) and atrioventricular plane displacement (AVPD). This study shows AVPD is coupled to SV, decreasing after AMI in swine models, with persistent effects on infarcted and remote myocardium.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Cardiac Physiology
Background:
- Acute myocardial infarction (AMI) can lead to heart failure with poor prognosis.
- Stroke volume (SV) is normally attributed to longitudinal ventricular motion, measured as atrioventricular plane displacement (AVPD).
- The relationship between SV and AVPD following AMI is not well understood.
Purpose of the Study:
- To determine how SV depends on AVPD before and after AMI in swine.
- To compare the effects of microembolization and ischemia-reperfusion models on SV and AVPD.
- To assess the temporal changes in SV-AVPD coupling after AMI.
Main Methods:
- Serial cardiac magnetic resonance imaging in swine models (microembolization and ischemia-reperfusion).
- Analysis of cine and late gadolinium enhancement images for cardiac function, AVPD, and infarct size.
- Measurements taken before AMI, 1-2 hours post-AMI, and in a subset at 24 hours and 7 days.
Main Results:
- AMI caused significant decreases in both AVPD and SV (P < 0.05 and P < 0.001, respectively).
- The ischemia-reperfusion model resulted in greater SV reduction and AVPD decrease compared to microembolization.
- Diastolic early filling AVPD decreased post-AMI, while atrial contraction AVPD remained unchanged.
Conclusions:
- AVPD is coupled to SV independently of infarct type, with a stronger association in ischemia-reperfusion infarcts.
- AMI acutely and persistently depresses AVPD in both infarcted and remote myocardium.
- Findings highlight the physiological significance of atrioventricular plane motion in assessing myocardial infarction.
Abstract:
Acute myocardial infarction (AMI) can progress to heart failure, which has a poor prognosis. Normally, 60% of stroke volume (SV) is attributed to the longitudinal ventricular shortening and lengthening evident in the atrioventricular plane displacement (AVPD) during the cardiac cycle, but there is no information on how the relationship changes between SV and AVPD before and after AMI. Therefore, the aim of this study was to determine how SV depends on AVPD before and after AMI in two swine models. Serial cardiac magnetic resonance imaging was carried out before and 1-2 h after AMI in a microembolization model (n = 12) and an ischemia-reperfusion model (n = 14). A subset of pigs (n = 7) were additionally imaged at 24 h and at 7 days. Cine and late gadolinium enhancement images were analyzed for cardiac function, AVPD measurements and infarct size estimation, respectively. AVPD decreased (P < 0.05) in all myocardial regions after AMI, with a concomitant SV decrease (P < 0.001). The ischemia-reperfusion model affected SV to a higher degree and had a larger AVPD decrease than the microembolization model (-29 ± 14% vs. -15 ± 18%; P < 0.05). Wall thickening decreased in infarcted areas (P < 0.001), and A-wave AVPD remained unchanged (P = 0.93) whereas E-wave AVPD decreased (P < 0.001) after AMI. We conclude that AVPD is coupled to SV independent of infarct type but likely to a greater degree in ischemia-reperfusion infarcts compared with microembolization infarcts. AMI reduces diastolic early filling AVPD but not AVPD from atrial contraction. These findings shed light on the physiological significance of atrioventricular plane motion when assessing acute and subacute myocardial infarction.NEW & NOTEWORTHY The link between cardiac longitudinal motion, measured as atrioventricular plane displacement (AVPD), and stroke volume (SV) is investigated in swine after acute myocardial infarction (AMI). This cardiac magnetic resonance study demonstrates a close coupling between AVPD and SV before and after AMI in an experimental setting and demonstrates that this connection is present in ischemia-reperfusion and microembolization infarcts, acutely and during the first week. Furthermore, AVPD is equally and persistently depressed in infarcted and remote myocardium after AMI.
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