Circulation, Vol 87, 355-362, Copyright © 1993 by American Heart Association
H Ito, T Tomooka, N Sakai, Y Higashino, K Fujii, O Katoh, T Masuyama, A Kitabatake and T Minamino
BACKGROUND. The beneficial effect of coronary reflow on myocardial salvage
may be assessed more accurately than in previous studies if the size of
risk area is taken into account, particularly because the size of risk area
varies significantly among patients. In this study, the risk area was
determined with myocardial contrast echocardiography to investigate the
time course of functional recovery of postischemic myocardium within the
risk area in patients with reperfused anterior myocardial infarction.
METHODS AND RESULTS. The study population consisted of 21 patients with
anterior myocardial infarction who achieved coronary reflow within 6 hours
of onset by means of thrombolysis or coronary angioplasty. Myocardial
contrast echocardiography was performed with the injection of hand-agitated
Haemaccel (5 ml) into the right and left coronary arteries before coronary
reflow, and the risk area was defined as the area of contrast perfusion
defect in the apical long-axis view. The ratio of the endocardial length of
abnormal contraction (dyskinesis/akinesis) segment to that of contrast
defect segment (AS/CD) was determined at days 1, 2, 3, 7, 14, and 28 of
reflow. Before reflow, the length of contrast defect correlated well with
the segment length of dyskinesis/akinesis. The values for AS/CD in patients
with successful reperfusion significantly and progressively decreased until
day 14; 1.00 +/- 0.02 at day 1, 0.93 +/- 0.11 at day 2 (p < 0.05 versus
day 1), 0.84 +/- 0.16 at day 3 (p < 0.05 versus day 2), 0.80 +/- 0.13 at
day 7 (p < 0.01 versus day 2), 0.73 +/- 0.10 at day 14, and 0.72 +/-
0.10 at day 28. Greater improvement in function was obtained in patients
reperfused within 4 hours than in those reperfused at > or = 4 hours
(AS/CD at day 28, 0.64 +/- 0.12 versus 0.75 +/- 0.09, p < 0.05).
CONCLUSIONS. Thus, a significant amount of myocardium, an average of 28% in
segment length of the risk area, is salvaged in patients with reperfused
anterior myocardial infarction. Major functional improvement seems to be
achieved within 14 days of reflow.
ARTICLES
Time course of functional improvement in stunned myocardium in risk area in patients with reperfused anterior infarction
Division of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan.
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