What is the clinical evidence from this study?

Study design: Observational. Population: Acute myocardial infarction (n=38). Intervention: Extent of myocardial injury (late gadolinium enhancement and edema). Primary outcome: Correlation between extent of late gadolinium enhancement and left ventricular ejection fraction (r = -0.57, p=<0.001).

What does this research mean for the field?

In patients with early reperfused acute myocardial infarction, the extent of myocardial scarring significantly correlates with left ventricular systolic function, whereas diastolic function is independently determined by age and non-infarcted myocardial function rather than the extent of injury. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

February 10, 2014Open Access

Different contribution of extent of myocardial injury to left ventricular systolic and diastolic function in early reperfused acute myocardial infarction

Q: What are the key findings of this study?

In patients with early reperfused acute myocardial infarction, the extent of myocardial scarring significantly correlated with left ventricular ejection fraction (r = -0.57, p < 0.001), while diastolic function was independently determined by age and non-infarcted myocardial function rather than the extent of injury.

Q: What does this research mean for the field?

In patients with early reperfused acute myocardial infarction, the extent of myocardial scarring significantly correlates with left ventricular systolic function, whereas diastolic function is independently determined by age and non-infarcted myocardial function rather than the extent of injury. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

In patients with early reperfused acute myocardial infarction, the extent of myocardial scarring significantly correlated with left ventricular ejection fraction (r = -0.57, p < 0.001), while diastolic function was independently determined by age and non-infarcted myocardial function rather than the extent of injury.

Study Design

Type

Observational (n=38)

Multicenter

Structured PICO

Population

38 patients with acute myocardial infarction (30 STEMI, 8 NSTEMI) who underwent successful percutaneous coronary intervention within 48 hours of chest pain. Mean age 52.8, 92% male, based in Republic of Korea. Exclusions: prior MI, claustrophobia, eGFR < 30 ml/min, valvular heart disease more than a moderate degree, underlying cardiomyopathies, cardiac implantable device except for coronary stents.

Outcome

Correlation of the extent of myocardial injury (assessed by late gadolinium enhancement and T2-weighted imaging) with left ventricular systolic and diastolic function indices (assessed by echocardiography and speckle tracking)surrogate

In patients with early reperfused acute myocardial infarction, left ventricular diastolic function is more strongly determined by age and the function of non-infarcted myocardium rather than the extent of myocardial injury.

Main Result

Effect estimate: r = -0.57

p-value: p=<0.001

Limitations

Did not directly measure the tissue characteristics of the non-infarcted myocardium.
Non-LGE or non-edema area could not be exactly matched with echocardiographic segments.
Used tissue Doppler-derived LV end-diastolic pressure instead of an invasive method.
All enrolled patients underwent timely, successful PCI resulting in a limited extent of myocardial injury.
Using septal e' in patients with regional wall motion abnormalities may have limitations.

Abstract

BACKGROUND: We sought to investigate the influence of the extent of myocardial injury on left ventricular (LV) systolic and diastolic function in patients after reperfused acute myocardial infarction (AMI). METHODS: Thirty-eight reperfused AMI patients underwent cardiac magnetic resonance (CMR) imaging after percutaneous coronary revascularization. The extent of myocardial edema and scarring were assessed by T2 weighted imaging and late gadolinium enhancement (LGE) imaging, respectively. Within a day of CMR, echocardiography was done. Using 2D speckle tracking analysis, LV longitudinal, circumferential strain, and twist were measured. RESULTS: Extent of LGE were significantly correlated with LV systolic functional indices such as ejection fraction (r = -0.57, p < 0.001), regional wall motion score index (r = 0.52, p = 0.001), and global longitudinal strain (r = 0.56, p < 0.001). The diastolic functional indices significantly correlated with age (r = -0.64, p < 0.001), LV twist (r = -0.39, p = 0.02), average non-infarcted myocardial circumferential strain (r = -0.52, p = 0.001), and LV end-diastolic wall stress index (r = -0.47, p = 0.003 with e') but not or weakly with extent of LGE. In multivariate analysis, age and non-infarcted myocardial circumferential strain independently correlated with diastolic functional indices rather than extent of injury. CONCLUSIONS: In patients with timely reperfused AMI, not only extent of myocardial injury but also age and non-infarcted myocardial function were more significantly related to LV chamber diastolic function.

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Cite This Study

Chung et al. (Mon,) conducted a observational in Acute myocardial infarction (n=38). Extent of myocardial injury (late gadolinium enhancement and edema) was evaluated on Correlation between extent of late gadolinium enhancement and left ventricular ejection fraction (r = -0.57, p=<0.001). In patients with early reperfused acute myocardial infarction, the extent of myocardial scarring significantly correlated with left ventricular ejection fraction (r = -0.57, p < 0.001), while diastolic function was independently determined by age and non-infarcted myocardial function rather than the extent of injury.

synapsesocial.com/papers/6a16a9071375058a29052692 https://doi.org/https://doi.org/10.1186/1476-7120-12-6

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