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. 2017 Dec 17:11:1179546817746636.
doi: 10.1177/1179546817746636. eCollection 2017.

Improvements in Regional Left Ventricular Function Following Late Percutaneous Coronary Intervention for Anterior Myocardial Infarction

Srilakshmi M Adhyapak  1 , Prahlad G Menon  2   3   4   5 , Kiron Varghese  1 , Abhinav Mehra  5 , S B Lohitashwa  1 , Fabio Fantini  6
Affiliations

Improvements in Regional Left Ventricular Function Following Late Percutaneous Coronary Intervention for Anterior Myocardial Infarction

Srilakshmi M Adhyapak et al. Clin Med Insights Cardiol. .

Abstract

Background: Late revascularization following a myocardial infarction has questionable clinical benefit.

Methods: We studied 13 patients with anterior wall myocardial infarction who underwent percutaneous coronary intervention within 2 weeks of the primary event, by quantitative analysis of 2-dimensional echocardiographic images. Endocardial segmentations of the left ventricular (LV) endocardium from the 4-chamber views were studied over time to establish cumulative wall displacements (CWDs) throughout the cardiac cycle.

Results: Left ventricular end-systolic volume decreased to 42 ± 8 mL/body surface area (P = .034) and LV ejection fraction improved to 52% ± 7% (P = .04). Analysis of LV endocardial CWD demonstrated significant improvements in mid-systolic to late-systolic phases in the apical LV segments, from 3.5 ± 0.32 to 5.89 ± 0.43 mm (P = .019). Improvements in CWD were also observed in the late-diastolic phase of the cardiac cycle, from 1.50 ± 0.42 to 1.76 ± 0.52 mm (P = .04).

Conclusions: In our pilot patient cohort, following late establishment of infarct-related artery patency following an anterior wall myocardial infarction, regional improvements were noted in the LV apical segments during systole and late diastole.

Keywords: Myocardial infarction; infarct-related artery patency; percutaneous coronary intervention; revascularization.

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Conflict of interest statement

Declaration of conflicting interests:The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Automated LV segmentation from 4 chamber long axis echocardiographic images. (A) at each frame of a time series imaging sequence, followed by regional analysis of cumulative displacement from the end-diastolic phase (E). Representative segmentation results in the end-dyastolic phase (D) are the regional curvature outlines of Poisson surface reconstructions of an artificially extruded (ie normal to the image) 3D version of a thresholded active contour level set function (B) which was used to crop/isolate the original image frame and detect the LV region.
Figure 2.
Figure 2.
Average cumulative wall displacement (CWD) of the LV endocardium at baseline (blue) and after (red) percutaneous coronary interventions (PCI) following anterior-wall myocardial infarction.The error bars indicate standard deviation in the LV averaged CWD across the study cohort, before (blue) and after (red) PCI.
Figure 3.
Figure 3.
Regional average CWD in the septal, lateral and apical segments of the LV endocardiumpresented superimposed with theglobalLV averaged CWD at baseline (blue) following an anterior wall myocardial infarction and after (red) PCI.
Figure 4.
Figure 4.
Comparison of regional LV-averaged CWD at baseline and after PCI for a patient-specific case where improvements in LV function were seen after PCI.
Figure 5.
Figure 5.
Comparison of the maximal contractile LV region at baseline and after PCI for a patient-specific case where improvements in LV function were seen after PCI.
See this image and copyright information in PMC

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