Improvement of global and regional left ventricular function by percutaneous transluminal coronary angioplasty after myocardial infarction
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S Miketić1, J Carlsson, U Tebbe
1Department of Internal Medicine II (Cardiology and Nephrology), Klinikum Lippe-Detmold, Germany.
Insights
Successful percutaneous transluminal coronary angioplasty after myocardial infarction improves heart function. However, restenosis after the procedure prevents long-term recovery of left ventricular function.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Research
Background:
- Residual stenosis in the infarct-related artery post-thrombolysis predicts left ventricular function changes.
- Optimal timing for restoring infarct area perfusion remains undetermined.
Purpose of the Study:
- To evaluate the impact of elective percutaneous transluminal coronary angioplasty (PTCA) on left ventricular function after acute myocardial infarction.
- To assess changes in global ejection fraction and regional wall motion post-PTCA.
Main Methods:
- Prospective evaluation of 74 patients with first myocardial infarction, postinfarction ischemia, and residual stenosis.
- Successful coronary angioplasty performed on the infarct-related artery.
- Angiographic measurement of global ejection fraction and infarct region function before PTCA and at 6-month follow-up.
Main Results:
- Complete flow restoration post-PTCA led to significant improvement in global ejection fraction (56.8% to 62.3%) and regional wall motion.
- Patients with anterior wall infarction showed improved regional function (12.1% to 22.5%), as did those with inferior wall infarction (20.4% to 28.5%).
- Restenosis with reduced flow in 20% of patients did not result in any significant improvement in left ventricular function.
Conclusions:
- Successful coronary angioplasty with sustained normal flow significantly improves myocardial dysfunction post-infarction.
- Restenosis with compromised flow after PTCA hinders long-term recovery of left ventricular function.
Objectives:
This study was designed to evaluate how elective percutaneous transluminal coronary angioplasty of the infarct-related vessel after acute myocardial infarction affects global ejection fraction and regional wall function.
Background:
The severity of the residual stenosis of the infarct-related artery after thrombolysis is an important predictor of changes in left ventricular function; however, the optimal time to restore complete perfusion in the infarct area has not been determined.
Methods:
We prospectively evaluated patients with a first myocardial infarction, postinfarction ischemia and residual high grade stenosis with reduced flow in the infarct-related artery who underwent successful coronary angioplasty. The group comprised 74 patients (61 men, 13 women with a mean age +/- SD of 55.9 +/- 9.9 years). Global ejection fraction and infarct region function (expressed as area ejection fraction) were angiographically measured before coronary angioplasty (3.9 +/- 2.1 weeks after infarction) and on routine follow-up study 6 +/- 1 months after angioplasty.
Results:
Restenosis with reduced flow occurred in 15 patients (20%). The global ejection fraction in patients with complete flow at follow-up increased significantly from 56.8% +/- 12% to 62.3% +/- 12.5% (p < 0.001). Regional wall motion of the infarct area increased from 12.1% to 22.5% (p = 0.001) in patients with anterior wall infarction and from 20.4% to 28.5% (p = 0.002) in those with inferior wall infarction. In patients with restenosis there was no difference at follow-up either in global ejection fraction (from 47.7% +/- 7.7% to 47.1% +/- 12.7%, p = 0.57) or in regional wall motion of the infarct area.
Conclusions:
Global and regional myocardial dysfunction due to postinfarction ischemia lessens significantly after successful coronary angioplasty of the infarct-related coronary artery with long-term sustained normal, complete flow. In contrast, restenosis with reduced flow prevents long-term improvement of left ventricular function.