Early recovery of regional left ventricular function after reperfusion in acute myocardial infarction assessed by serial two-dimensional echocardiography

• Published in: The American journal of cardiology Vol. 63; no. 11; pp. 641 - 646
• Main Authors: Bourdillon, Patrick D.V., Broderick, Thomas M., Williams, Eric S., Davis, Cris, Dillon, James C., Armstrong, William F., Fineberg, Naomi, Ryan, Thomas, Feigenbaum, Harvey
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 15-03-1989; Elsevier
• Subjects: Adult; Aged; Angioplasty, Balloon; Biological and medical sciences; Cardiology. Vascular system; Coronary heart disease; Echocardiography; Female; Heart; Humans; Male; Medical sciences; Middle Aged; Myocardial Contraction; Myocardial Infarction - diagnosis; Myocardial Infarction - therapy; Myocardial Reperfusion; Time Factors; Tissue Plasminogen Activator - therapeutic use; Heart; Human; Echocardiography; Infarct; Acute; Ultrasonic investigation; Instrumentation therapy; Cardiovascular disease; Coronary heart disease; Chemotherapy; Reperfusion; Myocardium; Hemodynamics; Left ventricle performance; Two dimensional technique
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/0002-9149(89)90243-9

Although global and regional left ventricular (LV) function has been demonstrated to improve after reperfusion in acute myocardial infarction (AMI), the timing of these changes has not been well established. In this study, serial 2-dimensional echocardiography was used to assess regional LV function in 23 patients with AMI in whom reperfusion was accomplished by thrombolysis alone, by coronary angioplasty alone or by both interventions within 6 hours after onset of chest pain. Echocardiograms were performed before or within 6 hours after reperfusion (n = 23) and at 1 (n = 19), 3 (n = 21) and 7 (n = 20) days after reperfusion. Wall motion index and percentage of normally functioning muscle were calculated using a 16-segment scoring system analyzed in blinded fashion without knowledge of patient identity, therapy or time of study. The mean wall motion index improved from 1.78 ± 0.48 to 1.56 ± 0.38 at 1 day (n = 19, p < 0.01), and to 1.48 ± 0.37 at 3–7 days (p < 0.01), with no significant difference between 3 days (1.49 ± 0.39) and 7 days (1.42 ± 0.30). There was a corresponding improvement in the percentage of normally functioning muscle, from 53 ± 24% at 6 hours to 62 ± 20% at 1 day (p < 0.05) and to 67 ± 18% at 3–7 days (p < 0.01), again with no significant difference between 3 days (67 ± 21) and 7 days (70 ± 20). The data indicate that in many patients with AMI and successful reperfusion there was a rapid improvement in LV wall motion abnormalities, often within 24 hours. In most patients maximal improvement was seen within 3 days.