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EXPRESS PUBLICATION

Myocardial wall thickness predicts recovery of contractile function after primary coronary intervention for acute myocardial infarction

Elena Biagini, MD^*, Tjebbe W. Galema, MD^*, Arend F. L. Schinkel, MD^*, Willem B. Vletter, MSc^*, Jos R. T. C. Roelandt, MD^* and Folkert J. Ten Cate, MD^*,*

^* Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
Institute of Cardiology, S. Orsola, Bologna, Italy

Manuscript received December 13, 2003; revised manuscript received February 9, 2004, accepted February 17, 2004.

^* Reprint requests and correspondence: Dr. Folkert J. Ten Cate, Erasmus Medical Center, Department of Cardiology, Thoraxcenter, Room Ba302, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
f.j.tencate{at}erasmusmc.nl

OBJECTIVES: We sought to determine whether end-diastolic wall thickness (EDWT) can predict recovery of regional left ventricular contractile function after percutaneous coronary intervention (PCI).

BACKGROUND: Regional contractile function does not recover in all patients after PCI for acute myocardial infarction (AMI). Prediction of functional recovery after AMI may help in clinical decision making.

METHODS: Forty consecutive patients with AMI were studied with left ventricular contrast echocardiography for accurate wall thickness and function measurement and myocardial perfusion immediately after and two months following PCI.

RESULTS: Out of 640 segments, 175 (27%) dysfunctional segments in the infarct territory were analyzed for EDWT, wall function, and perfusion. One hundred and three (59%) dysfunctional segments presented with an EDWT <11 mm and 72 (41%) presented with an EDWT 11 mm. Perfusion (partial or complete) was present in 63 segments with an EDWT <11 mm (61%) and 71 segments with an EDWT 11 mm (99%) (p < 0.001). At two months' follow-up, 66 of 72 segments with an EDWT 11 mm (92%) improved, whereas only 35 of 103 of the dysfunctional segments with an EDWT <11 mm (34%) improved (p < 0.0001).

CONCLUSIONS: Wall thickness is an easy parameter to predict recovery of function after revascularization. Moreover, combining EDWT and perfusion, segments with an EDWT 11 mm, and presence of perfusion have the highest chance of recovery; segments with an EDWT <11 mm and perfusion have an intermediate chance of recovery. In segments with an EDWT <11 mm and no perfusion, chances of recovery are very low.

Abbreviations and Acronyms   AMI = acute myocardial infarction   EDWT = end-diastolic wall thickness   LVEF = left ventricular ejection fraction   MCE = myocardial contrast echocardiography   PCI = percutaneous coronary intervention

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