Related Experiment Videos
[Changes of global and regional left-ventricular function by reperfusion in acute myocardial infarction]
Insights
Successful early reperfusion after myocardial infarction slightly improves left ventricular (LV) function. Regional wall motion changes after reperfusion are not accurately assessed by angiography.
Area of Science:
- Cardiology
- Medical Imaging
Context:
- Myocardial infarction (MI) can lead to impaired left ventricular (LV) function.
- Early reperfusion strategies aim to restore blood flow and improve outcomes.
- Assessing LV function and regional wall motion is crucial for evaluating treatment efficacy.
Purpose:
- To evaluate the impact of early reperfusion on global and regional LV function in patients with MI.
- To compare the effectiveness of different recanalization methods (intravenous streptokinase, intracoronary streptokinase, catheter manipulation).
- To assess the correlation between global LV function (ejection fraction) and regional wall motion parameters (akinetic segment length, number of akinetic radians).
Summary:
- Biplane ventriculography was used to assess LV function in 54 MI patients during acute and chronic stages.
- Successful early reperfusion (n=37) showed a slight average increase in LV ejection fraction (EFbi).
- Late reperfusion or permanent occlusion resulted in a significant decrease in EFbi and worsening regional akinesis.
- Global LV function (EF) correlated closely with the number of akinetic radians (Sak) but loosely with akinetic segment length (AKS).
Impact:
- Early reperfusion leads to a modest improvement in LV function, irrespective of the recanalization method.
- Angiographic determination of regional akinesis changes post-reperfusion has limitations in accuracy.
- Findings highlight the importance of early intervention in preserving cardiac function after MI.
Unlabelled:
Biplane ventriculography was performed during the acute and chronic stage (3 weeks) of myocardial infarction in 54 patients. Early recanalisation was attempted by intravenous streptokinase in 33, by intracoronary streptokinase in 15 and by catheter manipulation in 6 patients. In patients with successful recanalisation (n = 37) biplane LV ejection fraction (EFbi) increased slightly from 53 +/- 10 to 56 +/- 9% on the average, with late recanalisation or permanent occlusion EFbi decreased significantly from 47 +/- 11 to 39 +/- 8% (p less than 0.001). Correspondingly the akinetic segment length (AKS) and the number of akinetic radians (Sak) (semiautomated system) decreased with early recanalisation and increased with permanent occlusion. Comparing global and regional LV function, EF and Sak correlated closely (r = 0.81) while EF and AKS revealed only a loose correlation (r = 0.59). Biplane and RAO single plane EF correlated with an r-value of 0.88, Sy,x however was 9.9%. There was a considerable scatter in the relation between the parameters of regional wall motion, AKS and Sak (r = 0.80; Sy,x = 10.6).
Conclusions:
On the average there is a slight improvement in LV function after successful early reperfusion, which seems to be independent of the method of recanalisation. Changes of regional akinesis after reperfusion cannot be assessed accurately by angiographic determination.