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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

View larger version (39K): [in a new window]   Figure 1 Centerline method for analyzing wall motion through the cardiac cycle. (A) Envelopes are constructed demarcating the inner and outer bounds of the LV contours from every angiographic frame in the cardiac cycle. (B) A centerline is drawn midway between the inner and outer envelopes. Motion is measured along 100 chords constructed perpendicular to and evenly spaced along the centerline. To simplify the display and analysis, the LV contour is divided into 20 segments by averaging the motion at consecutive sets of five chords. Motion is normalized by the length of the end diastolic perimeter and expressed as a percent. LV = left ventricle.

View larger version (20K): [in a new window]   Figure 2 (A) Example of wall motion in an akinetic segment. (B) Example of postsystolic shortening with motion of the LV wall to a position inside the end diastolic contour. (C) Example of dyskinetic wall motion: inward motion during diastole brings the wall back towards but not within the end diastolic contour. ED = end diastole to end diastole; ES = end systole; LV = left ventricle. Solid line = patient’s motion; dashed line = mean motion of the normal group; dotted line = one standard deviation above and below the normal mean. The segment number is displayed.

View larger version (35K): [in a new window]   Figure 3 Change in wall motion in the infarct region over time from baseline until one year follow-up study in patients with anterior and inferior myocardial infarction (MI). PTCA = percutaneous transluminal coronary angioplasty.

View larger version (29K): [in a new window]   Figure 4 Example of recovery of LV wall motion in a patient with anterior MI. Top, Preangioplasty. Bottom, Three months after angioplasty. EF = ejection fraction; L = left anterior descending coronary artery; LV = left ventricle; RAO = right anterior oblique; ROI = region of interest; SD = standard deviation.

View larger version (21K): [in a new window]   Figure 5 Normal mean and standard deviation for wall motion during isovolumic relaxation and for postsystolic shortening. Motioniso = motion during isovolumic relaxation.

View larger version (21K): [in a new window]   Figure 6 Wall motion in anterior and inferior myocardial infarction (MI) during isovolumic relaxation, compared with normal patients.

View larger version (27K): [in a new window]   Figure 7 Postsystolic shortening in patients with anterior and inferior myocardial infarction (MI) compared with normal patients. *Left ventricular segments at which shortening values differ significantly (p < 0.05) between the three groups by analysis of variance.

View larger version (14K): [in a new window]   Figure 8 Relationship between recovery of wall motion in the infarct region after three months in patients with anterior myocardial infarction (MI) and peak total postsystolic shortening measured at the baseline, preangioplasty angiogram. %FS = fractional shortening. Black circles = data of one patient.