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Regional myocardial shape alterations in patients with anterior myocardial infarction
L H Baur1, J J Schipperheyn, E E van der Wall
1Department of Cardiology, University Hospital Leiden, The Netherlands.
Objective:
To assess the impact of regional left ventricular curvature in patients with an acute anterior myocardial infarction on ventricular volume.
Methods:
Left ventricular curvature was calculated at 100 points from apical four chamber echocardiograms of 68 patients with an acute anterior wall infarction. Curvature at any point of the contour was defined as the reciprocal of the radius of the circle that intersects that point tangentially and was independent of volume and geometric assumptions. Curvature, volume and shape of the patient group was compared with these measurements in 20 normal volunteers.
Results:
Diastolic curvature differed at the borderzone of the infarct and the apical area. In the basal septal area (point 9-18) mean curvature was lower in the patient group (0.1 +/- 2.7 versus 2.1 +/- 0.7; p < 0.0001) as compared to the normal individuals. In the mid-septal area (point 22 to 27), mean curvature was more concave (-0.1 +/- 2.6) in the patient group corresponding to in the normal population (-0.4 +/- 1.3) p < 0.005. In the apex point 52 and 53 diverged with a curvature of 9.9 +/- 1.9 in patients versus 9.4 +/- 2.9 p < 0.005 in normal individuals. Systolic curvature diverged at the basal septum (point 1-4) with a mean curvature of 1.4 +/- 1.1 in patients compared to 3.5 +/- 2.5 in normal individuals p < 0.01. Curvature differed also in the mid-septal region (point 9-29) with a curvature of -1.7 +/- 1.2 in patients versus 0.4 +/- 0.9 (p < 0.01) in normal individuals and in the apical septum (point 48-52) with a curvature of 16.6 +/- 5.2 in patients and 13.9 +/- 2.6 (p < 0.0001) in healthy individuals Separation of patients with the greatest curvature alteration to those with minor curvature change revealed, that baseline curvature analysis can discriminate patients at risk for left ventricular remodelling.
Conclusion:
Regional curvature analysis correctly identifies the geometric changes induced by myocardial infarction. Apical systolic curvature can distinguish those patients that are at risk for left ventricular remodelling from those who are not at risk.