Remote non-infarct segment kinesis. Influence of clinical and angiographic findings "a tissue doppler study"

ABSTRACT

Regional wall motion is closely related to the status of the myocardium. Two-dimension tissue Doppler imaging provides a valuable quantitative assessment of wall motion in normal and ischemic dysfunctioning myocardium. The aim of this study was to evaluate the contractile status of the remote non-infarct segment in setting of myocardial infarction and to clarify the influence of patients clinical profile and extent of coronary artery disease on the myocardial kinetics in remote segments. Using pulsed tissue Doppler imaging in short axis parasternal view, at the mid-papillary muscle level, the peak myocardial systolic velocities [S waves] were assessed in the anteroseptum and posterior wall in 30 patients with acute inferior myocardial infarction with marked asynergy observed in the infracted wall. Similar measurements were obtained in 15 matched healthy controls. In patients with inferior wall myocardial infarction, the peak systolic myocardial velocities were significantly higher in the anteroseptum wail when compared to controls [21 +/- 2.4 versus 19.34 +/- 2.6; P <0.05]. conversely, the peak systolic myocardial velocities in the posterior wall were significantly lower in patients than controls [11.48 +/- 6.2 versus 21.86 +/- 2.1; p <0.01]. Compensatory remote, non-infarct segment hyperkinesis was significantly reduced or blunted in patients with the metabolic syndrome compared with patients without [21.32 +/- 2.1 versus 24.22 +/- 2.1; p <0.05]. Patients with the metabolic syndrome had higher prevalence of multi-vessel disease and jeopardized remote non-infarct segment and tended to have lower overall left ventricular ejection fraction [LVEF] [42 +/- 3.2 versus 48 +/- 5.1; P = 0.05]. Patients with single vessel disease in infarct related vessel had the highest values of peak systolic myocardial velocities in the remote non-infarct segment compared to patients with two or three vessel disease [25.11 +/- 2.2 versus 19 +/- 3.7; P <0.05] representing a preserved hyperkinesis in the remote segment. Compensatory hyperkinesis in remote non-infarct segment can be easily identified using pulsed tissue Doppler imaging as significant increase in peak systolic myocardial velocity which would have an impact on overall LVEF in sitting of acute myocardial infarction. Patients with high risk clinical profile, higher plaque burden and multivessel coronary artery disease had blunted or reduced hyperkinetic response in the remote non-infarct segments due to remote jeopardized myocardium