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Left ventricular dysfunction in excess of the size of infarction: a possible management strategy
M L Smucker1, G A Beller, D D Watson
1Department of Medicine, University of Virginia School of Medicine, Charlottesville 22908.
Insights
Severe left ventricular dysfunction disproportionate to infarct size improved after revascularization surgery in two patients with multivessel coronary artery disease. This suggests improved function in remote myocardial beds post-revascularization.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Cardiac Surgery
Background:
- Left ventricular dysfunction (LVD) can exceed myocardial infarction (MI) size.
- Assessing LVD extent and its relationship to infarct size is crucial for patient outcomes.
Observation:
- Two patients presented with LVD significantly greater than indicated by ECG and creatine kinase levels.
- Delayed rest thallium-201 imaging revealed perfusion abnormalities in myocardial areas distant from the infarct zone.
- Coronary angiography confirmed multivessel coronary artery disease in both patients.
Findings:
- Revascularization surgery led to symptom relief and enhanced regional and global left ventricular function.
- Improvement in LVD suggests that remote myocardial beds may recover function after intervention.
- The study highlights potential mechanisms for LVD in areas not directly affected by infarction.
Implications:
- Revascularization may be beneficial for patients with disproportionate LVD, even with extensive coronary artery disease.
- Understanding mechanisms of remote LVD can refine treatment strategies for ischemic heart disease.
- This case report emphasizes the importance of comprehensive assessment and intervention in complex cardiac conditions.
Abstract:
In this report we describe two patients whose left ventricular dysfunction was far in excess of infarct size as evidenced by ECG changes and the magnitude of creatine kinase release. Both patients demonstrated redistribution in myocardial beds remote from the infarct zone on delayed rest thallium 201 images and both had multivessel disease evident on coronary angiography. Both patients experienced relief of symptoms and improvement in regional and global left ventricular function after revascularization surgery. The possible mechanisms of left ventricular dysfunction in myocardial beds remote from the zone of infarction are discussed.