TY - JOUR
T1 - Left ventricular muscle and fluid mechanics in acute myocardial infarction
AU - Nucifora, Gaetano
AU - Delgado, Victoria
AU - Bertini, Matteo
AU - Marsan, Nina Ajmone
AU - Van De Veire, Nico R.
AU - Ng, Arnold C.T.
AU - Siebelink, Hans Marc J.
AU - Schalij, Martin J.
AU - Holman, Eduard R.
AU - Sengupta, Partho P.
AU - Bax, Jeroen J.
N1 - Funding Information:
Dr. Schalij has received research grants from Biotronik (Berlin, Germany), Boston Scientific (Natick, Massachusetts), and Medtronic (Minneapolis, Minnesota). Dr. Bax has received research grants from Biotronik (Berlin, Germany), BMS Medical Imaging (North Billerica, Massachusetts), Boston Scientific (Natick, Massachusetts), Edwards Lifesciences (Irvine, California), GE Healthcare (Buckinghamshire, United Kingdom), Medtronic (Minneapolis, Minnesota), and St. Jude Medical (St. Paul, Minnesota).
Funding Information:
Dr. Nucifora was financially supported by the Research Fellowship of the European Association of Percutaneous Cardiovascular Interventions . Drs. Ajmone Marsan and Delgado were financially supported by the Research Fellowship of the European Society of Cardiology .
PY - 2010/11/15
Y1 - 2010/11/15
N2 - Left ventricular (LV) diastolic filling is characterized by the formation of intraventricular rotational bodies of fluid (termed "vortex rings") that optimize the efficiency of LV ejection. The aim of the present study was to evaluate the morphology and dynamics of LV diastolic vortex ring formation early after acute myocardial infarction (AMI), in relation to LV diastolic function and infarct size. A total of 94 patients with a first ST-segment elevation AMI (59 ± 11 years; 78% men) were included. All patients underwent primary percutaneous coronary intervention. After 48 hours, the following examinations were performed: 2-dimensional echocardiography with speckle-tracking analysis to assess the LV systolic and diastolic function, the vortex formation time (VFT, a dimensionless index for characterizing vortex formation), and the LV untwisting rate; contrast echocardiography to assess LV vortex morphology; and myocardial contrast echocardiography to identify the infarct size. Patients with a large infarct size (<3 LV segments) had a significantly lower VFT (p <0.001) and vortex sphericity index (p <0.001). On univariate analysis, several variables were significantly related to the VFT, including anterior AMI, LV end-systolic volume, LV ejection fraction, grade of diastolic dysfunction, LV untwisting rate, and infarct size. On multivariate analysis, the LV untwisting rate (β = -0.43, p <0.001) and infarct size (β = -0.33, p = 0.005) were independently associated with VFT. In conclusion, early in AMI, both the LV infarct size and the mechanical sequence of diastolic restoration play key roles in modulating the morphology and dynamics of early diastolic vortex ring formation.
AB - Left ventricular (LV) diastolic filling is characterized by the formation of intraventricular rotational bodies of fluid (termed "vortex rings") that optimize the efficiency of LV ejection. The aim of the present study was to evaluate the morphology and dynamics of LV diastolic vortex ring formation early after acute myocardial infarction (AMI), in relation to LV diastolic function and infarct size. A total of 94 patients with a first ST-segment elevation AMI (59 ± 11 years; 78% men) were included. All patients underwent primary percutaneous coronary intervention. After 48 hours, the following examinations were performed: 2-dimensional echocardiography with speckle-tracking analysis to assess the LV systolic and diastolic function, the vortex formation time (VFT, a dimensionless index for characterizing vortex formation), and the LV untwisting rate; contrast echocardiography to assess LV vortex morphology; and myocardial contrast echocardiography to identify the infarct size. Patients with a large infarct size (<3 LV segments) had a significantly lower VFT (p <0.001) and vortex sphericity index (p <0.001). On univariate analysis, several variables were significantly related to the VFT, including anterior AMI, LV end-systolic volume, LV ejection fraction, grade of diastolic dysfunction, LV untwisting rate, and infarct size. On multivariate analysis, the LV untwisting rate (β = -0.43, p <0.001) and infarct size (β = -0.33, p = 0.005) were independently associated with VFT. In conclusion, early in AMI, both the LV infarct size and the mechanical sequence of diastolic restoration play key roles in modulating the morphology and dynamics of early diastolic vortex ring formation.
UR - http://www.scopus.com/inward/record.url?scp=78149454822&partnerID=8YFLogxK
U2 - 10.1016/j.amjcard.2010.06.072
DO - 10.1016/j.amjcard.2010.06.072
M3 - Article
C2 - 21059428
AN - SCOPUS:78149454822
SN - 0002-9149
VL - 106
SP - 1404
EP - 1409
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 10
ER -