Left ventricular diastolic dysfunction in patients with ST-elevation myocardial infarction following early and late reperfusion by coronary intervention.

BACKGROUND

This study prospectively assessed the left ventricular (LV) diastolic function changes in patients with ST-elevation myocardial infarction (STEMI) and determined if the early revascularization of the infarct-related coronary artery in acute phase achieve a better recovery of diastolic function than late recanalization.

METHODS

Forty-five consecutive patients (61.20±11.37years, 8 females) presenting with STEMI and treated with PCI were prospectively enrolled in this study. The important inclusion criteria were first acute coronary syndrome episode and LV ejection fraction exceeded 45%. The patients were divided to two different groups by total ischemia time (TIT): early reperfusion (TIT<6h) and late reperfusion group (TIT≥6h). Transthoracic echocardiography were performed within the first week after PCI, and data were compared between groups. Evaluation of diastolic function was based on integrated assessment of trans-mitral Doppler flow pattern, tissue Doppler, and color M-mode ECT.

RESULTS

A normal diastolic filling pattern was seen in only 9 patients, and the other 80% patients had abnormal filling patterns: 16 impaired relaxation, 14 pseudonormal, and 6 restrictive filling patterns. The e' velocity was lower in early reperfusion group compared to late reperfusion group (5.52±1.67cm/s vs 7.11±2.14cm/s, P<0.05), but no statistical difference was found in E/e' average (11.99±4.30 vs 9.85±3.47, P>0.05). There was also no statistical difference for left atrial volume index and mitral annulus propagation velocity between groups.

CONCLUSIONS

LV diastolic dysfunction was present in most of acute MI patients even after successful PCI. It seemed STEMI patients receiving early myocardial reperfusion had no better diastolic functions compared with late-reperfused patients within the acute phase.