EXPERIMENTAL STUDY
Intracardiac measurement of pre-ejection myocardial velocities estimates the transmural extent of viable myocardium early after reperfusion in acute myocardial infarction
Cristina Pislaru, MD*,*,
Charles J. Bruce, MD ,
Marek Belohlavek, MD, PhD, FACC,
James B. Seward, MD, FACC and
James F. Greenleaf, PhD*
* Department of Physiology and Biophysics, Mayo Clinic and Foundation, Rochester, Minnesota, USA
Division of Cardiovascular Diseases Internal Medicine, Mayo Clinic and Foundation, Rochester, Minnesota, USA
Manuscript received March 2, 2001;
revised manuscript received July 12, 2001,
accepted August 9, 2001.
* Reprint requests and correspondence: Dr. Cristina Pislaru, Mayo Clinic, Ultrasound Research Laboratory, 200 First Street SW, Rochester, Minnesota 55905 USA
Pislaru.Cristina{at}mayo.edu
OBJECTIVES
We hypothesized that wall motion velocity during pre-ejection is proportional to the regional content of viable myocardium after reperfusion for acute myocardial infarction (AMI).
BACKGROUND
Pre-ejection wall motion consists of short and fast inward and outward movement towards and away from the center of the left ventricle (LV) and is altered during regional ischemia. This short-lived event can be accurately quantified by Doppler myocardial imaging (DMI).
METHODS
Fourteen open-chest pigs underwent 60 to 120 min of left anterior descending coronary artery occlusion followed by 30 min of reperfusion. The DMI data were collected using a phased-array intracardiac catheter (LV cavity) from ischemic and nonischemic myocardium encompassed within a plane passing through two epicardial bead markers. Peak tissue velocities during isovolumic contraction (IVC) (peak positive and peak negative), ejection (S) and early filling (E) were measured. The cardiac specimen was sliced through the epicardial markers in a plane approximating the ultrasound imaging plane. The transmural extent of necrosis (TEN) (%) was measured by triphenyltetrazolium chloride staining.
RESULTS
During ischemia, positive IVC velocity was zero in ischemic walls with TEN >20%. At reperfusion, positive IVC velocity correlated better with TEN (r = –0.94, p < 0.0001) than it did S (r = –0.70, p < 0.01) and E (r = –0.81, p < 0.01). Differential IVC (the difference between peak positive and peak negative velocity) highly correlated with TEN, during ischemia (r = –0.78, p < 0.001) and during reperfusion (r = –0.93, p < 0.0001).
CONCLUSIONS
Pre-ejection tissue velocity, as measured by intracardiac ultrasound, allows rapid estimation of the transmural extent of viable myocardium after reperfusion for AMI.
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Abbreviations and Acronyms
| | AMI | = acute myocardial infarction | | DMI | = Doppler myocardial imaging | | E | = myocardial velocity due to early left ventricular filling | | IVC | = isovolumic contraction | | LAD | = left anterior descending coronary artery | | LV | = left ventricle or left ventricular | | MI | = myocardial infarction | | S | = myocardial velocity during ejection | | SWT | = systolic wall thickening | | TEN | = transmural extent of necrosis | | TTC | = 2,3,5-triphenyltetrazolium chloride |
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