Detection of residual myocardial function in acute transmural infarction using postextrasystolic potentiation. A computerized angiographic study.

Twelve subjects without clinical or hemodynamic heart failure, admitted for a first untreated anterior transmural myocardial infarction, were evaluated within the first 24 hours after the onset of symptoms. Pulmonary angiography was performed while a right ventricular extrastimulus was delivered every fourth beat at 50% of the RR interval to systematically analyze the basal and the postextrasystolic left ventricular frames. Left ventriculograms were quantitatively processed to determine the ejection fraction (EF) and the percentage of the end-diastolic circumference showing hypokinetic (%HK) or akinetic (%AK) areas. Left ventricular angiography was performed 1 month later in all cases at the same paced atrial heart rate to compare this final angiogram to the basal and the electrically induced postextrasystolic initial beats. During the 1-month period of the study none of these subjects had complications such as recurrent chest pain, heart failure or rhythm disturbances, and no drug administration was necessary. Comparing the basal cycle of the initial angiogram and the final cycle, a poor correlation was found between the corresponding values of EF (r = 0.34), %HK (r = 0.38) and %AK (r = 0.48). The correlations were much better when a comparison was made between the postextrasystolic cycle of the initial angiogram and the final cycle (EF, r = 0.84; %HK, r = 0.96; %AK, r = 0.95). These results indicate that, from the first day after a TMI, the analysis of the postextrasystolic frame allows accurate estimation of the final left ventricular function and regional wall motion abnormalities. Postextrasystolic potentiation may be useful in the acute state of transmural infarction to discriminate potentially reversible ischemic from definitely jeopardized areas.