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In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Determinants and effects of microvascular obstruction on serial change in left ventricular diastolic function after
Hyemoon Chung1, Jiwon Seo2, In-Soo Kim2
1Division of Cardiology, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Republic of Korea.
Insights
Microvascular obstruction (MVO) impairs mid-term recovery of diastolic function after reperfused acute myocardial infarction (AMI). More sensitive measures like mitral inflow deceleration time and left ventricular elastance index showed less improvement in patients with MVO.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Myocardial Infarction Research
Background:
- Left ventricular (LV) diastolic dysfunction impacts functional capacity post-acute myocardial infarction (AMI).
- Determinants of LV diastolic functional changes after reperfused AMI are not fully understood.
- Microvascular obstruction (MVO) is a potential factor influencing these changes.
Purpose of the Study:
- To investigate the impact of microvascular obstruction (MVO) on mid-term changes in LV diastolic function.
- To identify sensitive indices of diastolic function recovery after reperfused AMI.
- To compare diastolic function changes in patients with and without MVO.
Main Methods:
- A cohort of 72 patients with reperfused AMI underwent serial echocardiography and cardiovascular magnetic resonance imaging at 9-month intervals.
- Assessed parameters included late gadolinium enhancement (LGE), LV and left atrial (LA) phasic functions, mitral inflow, and tissue Doppler measurements.
- Evaluated LV ejection fraction (LVEF), LV global longitudinal strain (GLS), mitral inflow deceleration time (DT), and LV elastance index (Ed).
Main Results:
- 43% of patients had MVO. Both LV ejection fraction and LV global longitudinal strain improved significantly over 9 months, with a decrease in LGE.
- Mitral inflow deceleration time and LV elastance index showed significant improvement, unlike conventional diastolic functional indexes.
- Improvements in these diastolic parameters were less pronounced in patients with MVO compared to those without.
- LGE amount and LVEF changes correlated with improvements in LV-Ed and LA function, not conventional diastolic indexes.
Conclusions:
- Deceleration time of early mitral inflow, phasic left atrial function, and LV elastance index are sensitive measures of diastolic function post-reperfusion.
- The recovery of these diastolic parameters is less prominent in patients with microvascular obstruction.
- MVO negatively affects mid-term diastolic functional recovery after reperfused AMI.
Background:
Although left ventricular (LV) diastolic dysfunction is more related to functional capacity after acute myocardial infarction (AMI), the determinants of LV diastolic functional change after reperfused AMI remain unknown. This study aimed to investigate the effects of microvascular obstruction (MVO) on mid-term changes in LV diastolic function after reperfused AMI.
Methods:
In a cohort of 72 AMI patients who underwent successful revascularization, echocardiography and cardiovascular magnetic resonance imaging were repeated at 9-month intervals. The late gadolinium enhancement (LGE) amount, segmental extracellular volume fraction, global LV, and left atrial (LA) phasic functions, along with mitral inflow and tissue Doppler measurements, were repeated.
Results:
Among the included patients, 31 (43%) patients had MVO. During the 9-month interval, LV ejection fraction (EF) and LV global longitudinal strain (GLS) were significantly improved in accordance with a decrease in LGE amount (from 18.2 to 10.3 g, p < 0.001) and LV mass. The deceleration time (DT) of early mitral inflow (188.6 ms-226.3 ms, p < 0.001) and LV elastance index (Ed; 0.133 1/ml-0.127 1/ml, p = 0.049) were significantly improved, but not in conventional diastolic functional indexes. Their improvements occurred in both groups; however, the degree was less prominent in patients with MVO. The degree of decrease in LGE amount and increase in LVEF was significantly correlated with improvement in LV-Ed or LA phasic function, but not with conventional diastolic functional indexes.
Conclusions:
In patients with reperfused AMI, DT of early mitral inflow, phasic LA function, and LV-Ed were more sensitive diastolic functional indexes. The degree of their improvement was less prominent in patients with MVO.
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