CLINICAL STUDIES
Remote myocardial dysfunction after acute anterior myocardial infarction: impact of left ventricular shape on regional function
A magnetic resonance myocardial tagging study
Jan Bogaert, MD*,
Hilde Bosmans, PhD*  ,
Alex Maes, MD*,
Paul Suetens, PhD,
Guy Marchal, MD* and
Frank E. Rademakers, MD*
* Department of Nuclear Medicine, the Interdisciplinary Research Unit for Radiological Imaging, University Hospitals, Leuven, Belgium and
Department of Cardiology, Radiology, and the Interdisciplinary Research Unit for Radiological Imaging, University Hospitals, Leuven, Belgium
Manuscript received October 21, 1998;
revised manuscript received December 3, 1999,
accepted January 17, 2000.
Reprint requests and correspondence: Dr. Jan Bogaert, Department of Radiology, University Hospitals, Catholic University of Leuven, Herestraat 49, B-3000 Leuven, Belgium.
Jan.Bogaert{at}uz.kuleuven.ac.be
OBJECTIVES
We sought to evaluate regional morphology and function in patients in their first week after having a reperfused anterior myocardial infarction (MI) using magnetic resonance (MR) myocardial tagging.
BACKGROUND
The mechanism of myocardial dysfunction in the remote, noninfarct-related regions is an unresolved issue to date.
METHODS
Sixteen patients with a first reperfused transmural anterior MI were studied with MR tagging at 5 ± 2 days after the event, and the results were compared with those of an age-matched control group regions. The left ventricle (LV) was divided into infarct, adjacent and remote regions. Magnetic resonance tagging provided information on the regional ventricular morphology and function.
RESULTS
Morphologically, an increase of the circumferential radius of curvature was found in the remote myocardium, whereas the longitudinal radius of curvature was increased in all regions of the LV. A significant increase in apical sphericity was also found. A significant reduction in strain and function was found not only in the infarct region, but also in the adjacent and remote myocardium. The loss in regional ejection fraction in the remote myocardium (61.4 ± 11.7% in patients vs. 68.7 ± 10.0% in control subjects, p < 0.0001) was related to a significant reduction of the longitudinal and circumferential strain, whereas systolic wall thickening was preserved.
CONCLUSIONS
Remote myocardial dysfunction contributes significantly to the loss in global ventricular function. This could be secondary to morphologic changes in the infarct region, leading to an increased systolic longitudinal wall stress without loss of intrinsic contractility in the remote regions.
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Abbreviations and Acronyms
| | EF | = ejection fraction | | 18FDG | = 18-flurodeoxyglucose | | LAD | = left anterior descending coronary artery | | LV | = left ventricle or ventricular | | MI | = myocardial infarction | | MR | = magnetic resonance | | 13NH3 | = nitrogen-13–ammonia | | PET | = positron emission tomography | | TIMI | = Thrombolysis in Myocardial Infarction trial |
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