title: Early and late changes in left ventricular filling after acute myocardial infarction and the effect of infarct size.
abstract: To characterize the early (1 week) and late (6 weeks) changes in left ventricular (LV) filling pattern associated with acute myocardial infarction (AMI) 45 patients (mean age 65 +/- 2 years) were studied by Doppler echocardiography. Based on clinical criteria, patients were divided into those with large (group L; n = 12) and those with small (group S; n = 33) infarcts and then compared with 16 age-matched control subjects. The following parameters were calculated from the mitral velocity waveform: (1) peak early and peak atrial velocities and their integrals; (2) peak early to atrial velocity ratio and velocity integral ratio; and (3) the pressure half-time of the early wave. One week after AMI, group L showed a decreased atrial and increased early velocity, velocity ratio and integral ratio, whereas the pressure half-time of the early wave was shorter than that in group S and in control subjects. At 6 weeks group L showed a reduction in early velocity, early to atrial velocity ratio and integral ratio, whereas pressure half-time increased. When groups S and L were combined there was a good inverse correlation between pressure half-time and infarct size as measured by peak enzyme release (r = -0.64, p < 0.001). These data suggest that, depending on infarct size, patients exhibit a "restrictive" filling pattern early after the acute event. This is manifested by the greater proportion of filling occurring in early diastole, reflecting an overall increase in chamber stiffness. At 6 weeks, this pattern is less pronounced presumably due to the remodeling process.
authors.affiliation: Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, United Kingdom.
authors.forename: A
authors.initials: A
authors.lastname: Pipilis
authors.forename: T E
authors.initials: TE
authors.lastname: Meyer
authors.forename: O
authors.initials: O
authors.lastname: Ormerod
authors.forename: M
authors.initials: M
authors.lastname: Flather
authors.forename: P
authors.initials: P
authors.lastname: Sleight
mesh_terms: D000368:Aged; D001219:Aspartate Aminotransferases / Q000493:pharmacokinetics; D016279:Atrial Function, Left / Q000502:physiology; D001783:Blood Flow Velocity; D001794:Blood Pressure; D002302:Cardiac Output / Q000502:physiology*; D015150:Echocardiography, Doppler; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D009200:Myocardial Contraction; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000201:enzymology / Q000473:pathology* / Q000503:physiopathology*; D009206:Myocardium / Q000201:enzymology / Q000473:pathology*; D011446:Prospective Studies; D016277:Ventricular Function, Left / Q000502:physiology*
chemical_list: D001219:Aspartate Aminotransferases