Pattern and Impact of Altered Regional Myocardial Excursion on Global Ventricular Performance After First-Time Acute Anterior Wall Myocardial Infarction by Real-Time Three-Dimensional Echocardiography

SUMMARY 

Background

The regional wall motion score index obtained by two-dimensional echocardiography in myocardial infarction (MI) has a significant impact on left ventricular (LV) global contractility and is of extraordinary prognostic value, whereas data regarding real-time three-dimensional echocardiography (RT-3DE) are lacking. We sought to clarify the relationship between RT-3DE and LV contractility in patients after MI.

Methods

RT-3DE was performed in 50 patients with anterior wall acute myocardial infarction and 30 normal controls. Global (16 segments) and regional ring-based LV systolic excursions were analyzed offline using the commercially available software Q-Lab version 5.0. The correlations between the LV global and regional systolic excursions and the global LV contractile performance were examined in the MI patients, and further compared with the control group.

Results

The global and regional (basal and middle ring-based) LV systolic excursions were lower in the MI patients (age, 61.8 ± 13.1 years) than in the normal controls (age, 40.0 ± 15.4 years). Global excursion showed inverse linear relationships with LV end-systolic volume (r =-0.26, p < 0.05) and end-diastolic volume (r =-0.22, p < 0.05) but no significant relationships with LV ejection fraction (p = 0.08) and stroke volume (p = 0.49).

Conclusion

Regional wall motion abnormalities quantified by RT-3DE are clinically convenient and feasible in both MI patients and the normal population. This rapid and objective quantification may also help discriminate abnormal from normal regional and global functions after infarction and, therefore, has the potential to be an attractive solution for clinical diagnosis.

Key Words:  anterior wall acute myocardial infarction , global ventricular performance , real-time three-dimensional echocardiography , regional myocardial excursion

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