Recovery of left ventricular function after primary angioplasty for acute myocardial infarction.
OBJECTIVE
To study recovery of segmental wall thickening (SWT), ejection fraction (EF), and end-systolic volume (ESV) after acute myocardial infarction (AMI) in patients who underwent primary stenting with drug-eluting stents. Additionally, to evaluate the predictive value of magnetic resonance imaging (MRI)-based myocardial perfusion and delayed enhancement (DE) imaging.


RESULTS
Twenty-two patients underwent cine-MRI, first-pass perfusion, and DE imaging 5 days after successful placement of a drug-eluting stent in the infarct-related coronary artery. Regional myocardial perfusion and the transmural extent of DE were evaluated. A per patient perfusion score was calculated and consisted of a summation of all segmental scores. Myocardial infarct size was quantified by measuring the volume of DE. At 5 months after AMI, cine-MRI was performed and SWT, EF, and ESV were quantified. EF increased from 48+/-11 to 55+/-9% (P<0.01). SWT at 5 months was inversely related to baseline segmental DE scores (P<0.001) and segmental perfusion scores (P<0.001). EF and ESV at 5 months were related to acute infarct size (R(2)=0.65; P<0.001 and R(2)=0.78; P<0.001, respectively) and the calculated perfusion score (R(2)=0.23; P=0.02 and R(2)=0.14; P=0.09, respectively) at baseline.


CONCLUSIONS
Marked recovery of left ventricular function was observed in patients receiving a drug-eluting stent for AMI. DE imaging appears to be a better prognosticator than perfusion imaging.
Baks
Timo
T
Department of Cardiology (Thoraxcenter), Erasmus MC-University Medical Center Rotterdam, Bd 410, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
van Geuns
Robert-Jan
RJ
Biagini
Elena
E
Wielopolski
Piotr
P
Mollet
Nico R
NR
Cademartiri
Filippo
F
Boersma
Eric
E
van der Giessen
Willem J
WJ
Krestin
Gabriel P
GP
Duncker
Dirk J
DJ
Serruys
Patrick W
PW
de Feyter
Pim J
PJ
D000704:Analysis of Variance; D003326:Coronary Circulation / Q000502:physiology; D004343:Drug Implants; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D020127:Recovery of Function; D012044:Regression Analysis; D015607:Stents; D013318:Stroke Volume / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology / Q000601:surgery*
D004343:Drug Implants