Recovery of left ventricular function after primary angioplasty for acute myocardial infarction

Abstract

<B>Aims</B> To study recovery of segmental wall thickening (SWT), ejection fraction (EF), and end-systolic volume (ESV) after acute myocardial infarction (AMI) in patients who underwent primary stenting with drug-eluting stents. Additionally, to evaluate the predictive value of magnetic resonance imaging (MRI)-based myocardial perfusion and delayed enhancement (DE) imaging. <B>Methods and results</B> Twenty-two patients underwent cine-MRI, first-pass perfusion, and DE imaging 5 days after successful placement of a drug-eluting stent in the infarct-related coronary artery. Regional myocardial perfusion and the transmural extent of DE were evaluated. A per patient perfusion score was calculated and consisted of a summation of all segmental scores. Myocardial infarct size was quantified by measuring the volume of DE. At 5 months after AMI, cine-MRI was performed and SWT, EF, and ESV were quantified. EF increased from 48 ± 11 to 55 ± 9% (<I>P</I> < 0.01). SWT at 5 months was inversely related to baseline segmental DE scores (<I>P</I> < 0.001) and segmental perfusion scores (<I>P</I> < 0.001). EF and ESV at 5 months were related to acute infarct size (<I>R</I>2 = 0.65; <I>P</I> < 0.001 and <I>R</I>2 = 0.78; <I>P</I> < 0.001, respectively) and the calculated perfusion score (<I>R</I>2 = 0.23; <I>P</I> = 0.02 and <I>R</I>2 = 0.14; <I>P</I> = 0.09, respectively) at baseline. <B>Conclusion</B> Marked recovery of left ventricular function was observed in patients receiving a drug-eluting stent for AMI. DE imaging appears to be a better prognosticator than perfusion imaging.