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CLINICAL STUDIES

Measurement of postsystolic shortening to assess viability and predict recovery of left ventricular function after acute myocardial infarction

^a National Toyohashi Higashi Hospital, Toyohashi, Japan
^* University of Washington, Seattle, Washington, USA

Manuscript received March 8, 1999; revised manuscript received December 16, 1999, accepted February 14, 2000.

Reprint requests and correspondence: Dr. Florence H. Sheehan, University of Washington, Box 356422, Seattle, Washington 98195-6422

OBJECTIVES

We sought to determine whether left ventricular (LV) postsystolic shortening in the region of acute myocardial infarction (MI) predicts functional recovery after primary angioplasty.

BACKGROUND

Previous studies in experimental animals have shown that postsystolic shortening during temporary coronary occlusion predicts functional recovery after reperfusion.

METHODS

Contrast ventriculography was performed on 35 patients with acute MI before and immediately after angioplasty, and one day, one month, three months and one year later. The centerline method was used to measure regional LV wall motion at end systole from all six ventriculograms as well as motion during isovolumic relaxation (motion_iso) and postsystolic shortening from end systole until the end of contraction. The ventriculograms of 23 patients with normal anatomy were similarly analyzed.

RESULTS

Wall motion at end systole improved significantly from baseline to follow-up in the infarct region. Postsystolic shortening at baseline correlated most closely with the recovery of wall motion at three months in patients with anterior infarction (r = 0.69, n = 25, p = 0.0001) but also with recovery at one month and one year. The correlation was slightly less powerful for motion_iso. Functional recovery could not be predicted from assessment of motion_iso and postsystolic shortening in patients with inferior infarction.

CONCLUSIONS

In patients with acute anterior MI, analysis of postsystolic shortening in the infarct region predicts the recovery of systolic LV function after reperfusion. Postsystolic shortening represents active contraction and indicates viable myocardium.

Abbreviations and Acronyms   LV = left ventricle   MI = myocardial infarction   motioniso = motion during isovolumic relaxation   %FS = percent fractional shortening   PTCA = percutaneous transluminal coronary angioplasty   SD = standard deviation

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