Clinical validity of longitudinal pre-ejectional myocardial velocity for identifying the transmural extent of viable myocardium: early after reperfusion of an infarct-related coronary artery.
BACKGROUND
Positive longitudinal pre-ejectional velocity (+PEVL) was recently reported to be a reliable index of myocardial recovery early after successful revascularization in myocardial infarction (MI); that is, it recognizes the transmural extent of viable myocardium. The applicability of PEVL in the real-world clinical setting for identifying the transmural extent of viable myocardium in reperfused recent MI was assessed.


RESULTS
Using tissue Doppler imaging, the resting basal and mid myocardial PEVLs were determined within 3 days after revascularization in 41 consecutive patients with recent MI. Infarct thickness was semi-quantified using delayed gadolinium-enhanced magnetic resonance imaging (MRI) at baseline and at 6-month follow up to differentiate transmural from nontransmural MI. The proportion of segments showing the presence of +PEVL was not significantly changed as infarct thickness increased (p=0.2), with 66.2% having +PEVL even in segments involving >75% transmural infarction. Moreover, +PEVL was found in a large fraction of segments with akinesia (70.4%). Specificity and negative predictive value of +PEVL for assessing infarct nontransmurality were disappointingly low (32.0% and 26.9%, respectively). All of these results were not altered when the 6-month follow-up MRI was done.


CONCLUSIONS
+PEVL cannot be regarded as a reliable marker for predicting the transmural extent of viable myocardium in recent MI.
Department of Internal Medicine, Cardiovascular Center, Seoul National University College of Medicine, Seoul National University Hospital, Korea.
Hyung-Kwan
HK
Kim
Yong-Jin
YJ
Kim
Sung-A
SA
Chang
Song-Yi
SY
Kim
Ho-Joon
HJ
Jang
Whal
W
Lee
Jin-Shik
JS
Park
Dae-Won
DW
Sohn
Byung-Hee
BH
Oh
Young-Bae
YB
Park
Yun-Shik
YS
Choi
D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology*; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D015425:Myocardial Reperfusion; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013318:Stroke Volume / Q000502:physiology*