title: Echocardiographic diastolic dysfunction and magnetic resonance infarct size in healed myocardial infarction treated with primary angioplasty.
abstract: BACKGROUND
  After acute myocardial infarction (MI) the severity of diastolic dysfunction by echocardiography represents an independent prognostic marker. However, the mechanisms whereby diastolic dysfunction portends an increased risk after MI are not fully understood. We investigated the relationship between echocardiographic diastolic dysfunction severity and infarct size quantitatively measured by contrast-enhanced magnetic resonance (ce-MR).
  
  
  METHODS
  Cross-sectional prospective study. We quantified "healed" infarct size by ce-MR measuring the percentage of delayed enhancement with respect to left ventricular mass and diastolic function by Doppler echocardiography. Both exams were scheduled at least 1 month after a first acute ST segment elevation MI (STEMI) successfully treated with primary angioplasty and stenting. To increase the specificity, individual echocardiographic parameters were integrated to grade global diastolic function in 4 grades: normal diastolic function, impaired relaxation with normal, or near-normal filling pressures; impaired relaxation with moderate elevation of filling pressures, and impaired relaxation with marked elevation of filling pressures, "restrictive filling."
  
  
  RESULTS
  We prospectively enrolled 52 patients (mean age 62 +/- 13 years, 77% men). ce-MR and echocardiography were performed 48 +/- 15 days after the MI. There was a significant but modest correlation between diastolic function grade and infarct size (r = 0.423, P = 0.002), which was independent of global and regional systolic function and persisted after further adjustment for age, sex, body surface area, left ventricular mass, end-diastolic volumes, and sphericity index (all P < 0.05). Among single echocardiographic variables, infarct size correlated best with tissue Doppler velocities Em (r =-0.307, P = 0.03), Am (r =-0.39, P = 0.005), and flow propagation velocity (r =-0.34, P = 0.015).
  
  
  CONCLUSIONS
  In healed STEMI successfully treated with primary angioplasty and stenting, diastolic function grade was independently albeit weakly correlated with infarct size. Therefore, the increased risk of diastolic dysfunction after MI is not fully explained by infarct size.
authors.affiliation: Department of Cardiology, Modena and Reggio Emilia University, Modena, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Barbieri
authors.forename: Francesca
authors.initials: F
authors.lastname: Bursi
authors.forename: Luigi
authors.initials: L
authors.lastname: Politi
authors.forename: Luca
authors.initials: L
authors.lastname: Rossi
authors.forename: Federica
authors.initials: F
authors.lastname: Fiocchi
authors.forename: Guido
authors.initials: G
authors.lastname: Ligabue
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pingitore
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Positano
authors.forename: Pietro
authors.initials: P
authors.lastname: Torricelli
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Modena
mesh_terms: D000800:Angioplasty, Balloon; D003287:Contrast Media; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005682:Gadolinium; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control*
chemical_list: D003287:Contrast Media; D005682:Gadolinium