European Journal of Echocardiography Advance Access originally published online on August 23, 2007
European Journal of Echocardiography 2008 9(4):458-465; doi:10.1016/j.euje.2007.06.007
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Full or pressure limited reperfusion of an acute myocardial infarct results in a different wall thickness and deformation of the distal myocardium – implications for clinical reperfusion strategies
Department of Cardiology, K.U.Leuven, Herestraat 49, B-3000 Leuven, Belgium
Received 18 January 2007; accepted after revision 20 June 2007; online publish-ahead-of-print 23 August 2007.
* Corresponding author. Tel:+32 16 343472; fax:+32 16 343467. E-mail address: bart.bijnens{at}med.kuleuven.be (B. Bijnens).
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Abstract |
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Aim: The study aim was to determine the sequence of changes in both wall thickness and function in ‘at risk’ myocardium (using M-mode and radial strain/strain-rate imaging) induced by reperfusion of an acute transmural infarction, and to relate these changes to the presence or absence of a pressure-limiting stenosis in the infarct related epicardial vessel.
Methods: Eighteen closed-chest pigs were randomized into two groups (each with nine animals). In Group I, 4 weeks prior to induction of an acute transmural infarct, a copper coated stent was implanted in the proximal circumflex artery (Cx) to create a coronary artery stenosis of between 30 and 95% lumen diameter. At 4 weeks, the stenotic Cx vessel was occluded for 90 min by inflation of a PTCA balloon placed proximal to the stenosis to produce an acute transmural infarction. In Group II (the control group), 90 min Cx occlusion was performed in a normal vessel. In both groups the resulting acute transmural infarction was reperfused after 90 min by removing the PTCA balloon. For both groups, cardiac ultrasound data, including strain/strain-rate imaging, were collected at all stages of the investigation for subsequent offline analysis.
Results: In both groups, acute reperfusion (TIMI flow 3 or 2), immediately increased infarct zone end-diastolic wall thickness due to the development of oedema. The acute increase in wall thickness was significantly higher in the non-stenotic animals as compared to the ones with a residual stenosis. Neither of the groups showed any tendency to normalize deformation (strain) during the reperfusion period.
Conclusion: In this experimental study, the measurement of end-diastolic wall thickness was a simple and non-invasive tool to monitor acute infarct reperfusion. It also provided information on the presence of a flow limiting stenosis in the infarct related artery after restoration of the flow. The deformation of the myocardium remained impaired during early reperfusion, whether reflow was at full pressure or low pressure due to a residual stenosis in the infarct related artery.
Keywords: Reperfusion injury; Reperfusion oedema; Thrombolysis; Coronary angioplasty (PCI); Strain/strain-rate imaging
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