Non-uniform recovery of left ventricular transmural mechanics in ST-segment elevation myocardial infarction

Giuseppe Caracciolo, Mackram Eleid, Haruhiko Abe, Nisha Bhatia, F David Fortuin, Susan Wilansky, Scipione Carerj, Partho P. Sengupta

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: After a transient ischemic episode, the subendocardial region is more severely injured than outer subepicardial layers and may regain a proportionately greater degree of mechanical function in the longitudinal direction. We sought to explore left ventricular (LV) transmural mechanics in patients with ST-segment elevation myocardial infarction (STEMI) for determining the mechanism underlying recovery of global LV function after primary percutaneous coronary intervention (PCI). Methods: A total of 42 patients (62 ± 11 years old, 71% male) with a first STEMI underwent serial assessments of LV longitudinal, circumferential and radial strains (LS, CS and RS) by selective tracking of subendocardial and subepicardial regions within 48 hours and a median of 5 months after PCI. LV mechanical parameters were compared with sixteen age and gender matched normal controls. Results: In comparison with controls, endocardial and epicardial LS were markedly attenuated at 48 hours following PCI (P < 0.001). An improvement in LV ejection fraction (EF > 5%) following PCI was seen in 24 (57%) patients and was associated with improvement in endocardial and epicardial LS (P < 0.001 and P = 0.003, respectively) and endocardial CS (P = 0.01). Radial strain and wall motion score index, however, remained persistently abnormal. The change in endocardial LS (OR 1.2, 95% CI 1.03 to 1.42, P = 0.01) and the change in epicardial LS (OR 1.2, 95% 1.03 to 1.46, P = 0.02) were significantly associated with the improvement in LVEF, independent of the location of STEMI and the presence of underlying multivessel disease. Conclusions: In patients with STEMI treated by PCI, the recovery of LV subendocardial shortening strain seen in the longitudinal direction underlies the improvement in LV global function despite persistent abnormalities in radial mechanics and wall motion score index.

Original languageEnglish (US)
Article number31
JournalCardiovascular Ultrasound
Volume8
Issue number1
DOIs
StatePublished - 2010

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Percutaneous Coronary Intervention
Mechanics
Myocardial Infarction
Left Ventricular Function
ST Elevation Myocardial Infarction
Direction compound

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Non-uniform recovery of left ventricular transmural mechanics in ST-segment elevation myocardial infarction. / Caracciolo, Giuseppe; Eleid, Mackram; Abe, Haruhiko; Bhatia, Nisha; Fortuin, F David; Wilansky, Susan; Carerj, Scipione; Sengupta, Partho P.

In: Cardiovascular Ultrasound, Vol. 8, No. 1, 31, 2010.

Research output: Contribution to journalArticle

Caracciolo, Giuseppe ; Eleid, Mackram ; Abe, Haruhiko ; Bhatia, Nisha ; Fortuin, F David ; Wilansky, Susan ; Carerj, Scipione ; Sengupta, Partho P. / Non-uniform recovery of left ventricular transmural mechanics in ST-segment elevation myocardial infarction. In: Cardiovascular Ultrasound. 2010 ; Vol. 8, No. 1.
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abstract = "Background: After a transient ischemic episode, the subendocardial region is more severely injured than outer subepicardial layers and may regain a proportionately greater degree of mechanical function in the longitudinal direction. We sought to explore left ventricular (LV) transmural mechanics in patients with ST-segment elevation myocardial infarction (STEMI) for determining the mechanism underlying recovery of global LV function after primary percutaneous coronary intervention (PCI). Methods: A total of 42 patients (62 ± 11 years old, 71{\%} male) with a first STEMI underwent serial assessments of LV longitudinal, circumferential and radial strains (LS, CS and RS) by selective tracking of subendocardial and subepicardial regions within 48 hours and a median of 5 months after PCI. LV mechanical parameters were compared with sixteen age and gender matched normal controls. Results: In comparison with controls, endocardial and epicardial LS were markedly attenuated at 48 hours following PCI (P < 0.001). An improvement in LV ejection fraction (EF > 5{\%}) following PCI was seen in 24 (57{\%}) patients and was associated with improvement in endocardial and epicardial LS (P < 0.001 and P = 0.003, respectively) and endocardial CS (P = 0.01). Radial strain and wall motion score index, however, remained persistently abnormal. The change in endocardial LS (OR 1.2, 95{\%} CI 1.03 to 1.42, P = 0.01) and the change in epicardial LS (OR 1.2, 95{\%} 1.03 to 1.46, P = 0.02) were significantly associated with the improvement in LVEF, independent of the location of STEMI and the presence of underlying multivessel disease. Conclusions: In patients with STEMI treated by PCI, the recovery of LV subendocardial shortening strain seen in the longitudinal direction underlies the improvement in LV global function despite persistent abnormalities in radial mechanics and wall motion score index.",
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AU - Caracciolo, Giuseppe

AU - Eleid, Mackram

AU - Abe, Haruhiko

AU - Bhatia, Nisha

AU - Fortuin, F David

AU - Wilansky, Susan

AU - Carerj, Scipione

AU - Sengupta, Partho P.

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AB - Background: After a transient ischemic episode, the subendocardial region is more severely injured than outer subepicardial layers and may regain a proportionately greater degree of mechanical function in the longitudinal direction. We sought to explore left ventricular (LV) transmural mechanics in patients with ST-segment elevation myocardial infarction (STEMI) for determining the mechanism underlying recovery of global LV function after primary percutaneous coronary intervention (PCI). Methods: A total of 42 patients (62 ± 11 years old, 71% male) with a first STEMI underwent serial assessments of LV longitudinal, circumferential and radial strains (LS, CS and RS) by selective tracking of subendocardial and subepicardial regions within 48 hours and a median of 5 months after PCI. LV mechanical parameters were compared with sixteen age and gender matched normal controls. Results: In comparison with controls, endocardial and epicardial LS were markedly attenuated at 48 hours following PCI (P < 0.001). An improvement in LV ejection fraction (EF > 5%) following PCI was seen in 24 (57%) patients and was associated with improvement in endocardial and epicardial LS (P < 0.001 and P = 0.003, respectively) and endocardial CS (P = 0.01). Radial strain and wall motion score index, however, remained persistently abnormal. The change in endocardial LS (OR 1.2, 95% CI 1.03 to 1.42, P = 0.01) and the change in epicardial LS (OR 1.2, 95% 1.03 to 1.46, P = 0.02) were significantly associated with the improvement in LVEF, independent of the location of STEMI and the presence of underlying multivessel disease. Conclusions: In patients with STEMI treated by PCI, the recovery of LV subendocardial shortening strain seen in the longitudinal direction underlies the improvement in LV global function despite persistent abnormalities in radial mechanics and wall motion score index.

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