CLINICAL STUDY: MYOCARDIAL INFARCTION
Detailed endocardial mapping accurately predicts the transmural extent of myocardial infarction
Tamir Wolf, PhD*,
Lior Gepstein, MD, PhD*,
Uzi Dror, BSc*,
Gal Hayam, BSc*,
Rona Shofti, DVM*,
Asaph Zaretzky, DVM*,
Gideon Uretzky, MD ,
Uri Oron, PhD and
Shlomo A. Ben-Haim, MD, DSc*
* Cardiovascular System Laboratory, The Bruce Rappaport Faculty of Medicine, Carmel Medical Center, Technion-Israel Institute of Technology, Haifa, Israel
Department of Cardiothoracic Surgery, Carmel Medical Center, Technion-Israel Institute of Technology, Haifa, Israel
Department of Zoology, Tel Aviv University, Tel Aviv, Israel
Manuscript received October 3, 2000;
revised manuscript received December 28, 2000,
accepted January 24, 2001.
Reprint requests and correspondence: Dr. Tamir Wolf, Cardiovascular System Laboratory, The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Efron Street, POB 9649, Haifa 31096, Israel
mdwolf{at}tx.technion.ac.il
OBJECTIVES
This study delineates between infarcts varying in transmurality by using endocardial electrophysiologic information obtained during catheter-based mapping.
BACKGROUND
The degree of infarct transmurality extent has previously been linked to patient prognosis and may have significant impact on therapeutic strategies. Catheter-based endocardial mapping may accurately delineate between infarcts differing in the transmural extent of necrotic tissue.
METHODS
Electromechanical mapping was performed in 13 dogs four weeks after left anterior descending coronary artery ligation, enabling three-dimensional reconstruction of the left ventricular chamber. A concomitant reduction in bipolar electrogram amplitude (BEA) and local shortening indicated the infarcted region. In addition, impedance, unipolar electrogram amplitude (UEA) and slew rate (SR) were quantified. Subsequently, the hearts were excised, stained with 2,3,5-triphenyltetrazolium chloride and sliced transversely. The mean transmurality of the necrotic tissue in each slice was determined, and infarcts were divided into <30%, 31% to 60% and 61% to 100% transmurality subtypes to be correlated with the corresponding electrical data.
RESULTS
From the three-dimensional reconstructions, a total of 263 endocardial points were entered for correlation with the degree of transmurality (4.6 ± 2.4 points from each section). All four indices delineated infarcted tissue. However, BEA (1.9 ± 0.7 mV, 1.4 ± 0.7 mV, 0.8 ± 0.4 mV in the three groups respectively, p < 0.05 between each group) proved superior to SR, which could not differentiate between the second (31% to 60%) and third (61% to 100%) transmurality subgroups, and to UEA and impedance, which could not differentiate between the first (<30%) and second transmurality subgroups.
CONCLUSIONS
The degree of infarct transmurality extent can be derived from the electrical properties of the endocardium obtained via detailed catheter-based mapping in this animal model.
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Abbreviations and Acronyms
| | BEA | = bipolar electrogram amplitude | | 3D | = three-dimensional | | IV | = intravenously | | LAD | = left anterior descending | | LS | = local shortening | | LV | = left ventricle | | MI | = myocardial infarction | | SR | = slew rate | | TTC | = 2,3,5-triphenyltetrazolium chloride | | UEA | = unipolar electrogram amplitude |
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