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Nucifora, G.; Delgado, V.; Bertini, M.; Marsan, N.A.; Veire, N.R. van de; Ng, A.C.T.; ... ; Bax, J.J. (2010)

Left Ventricular Muscle and Fluid Mechanics in Acute Myocardial Infarction

Article / Letter to editor
Left ventricular (LV) diastolic filling is characterized by the formation of intraventricular rotational bodies of fluid (termed "vortex rings") that optimize the efficiency of LV ejection. The aim of the present study was to evaluate the morphology and dynamics of LV diastolic vortex ring formation early after acute myocardial infarction (AMI), in relation to LV diastolic function and infarct size. A total of 94 patients with a first ST-segment elevation AMI (59 +/- 11 years; 78% men) were included. All patients underwent primary percutaneous coronary intervention. After 48 hours, the following examinations were performed: 2-dimensional echocardiography with speckle-tracking analysis to assess the LV systolic and diastolic function, the vortex formation time (VFT, a dimensionless index for characterizing vortex formation), and the LV untwisting rate; contrast echocardiography to assess LV vortex morphology; and myocardial contrast echocardiography to identify the infarct size....Show moreLeft ventricular (LV) diastolic filling is characterized by the formation of intraventricular rotational bodies of fluid (termed "vortex rings") that optimize the efficiency of LV ejection. The aim of the present study was to evaluate the morphology and dynamics of LV diastolic vortex ring formation early after acute myocardial infarction (AMI), in relation to LV diastolic function and infarct size. A total of 94 patients with a first ST-segment elevation AMI (59 +/- 11 years; 78% men) were included. All patients underwent primary percutaneous coronary intervention. After 48 hours, the following examinations were performed: 2-dimensional echocardiography with speckle-tracking analysis to assess the LV systolic and diastolic function, the vortex formation time (VFT, a dimensionless index for characterizing vortex formation), and the LV untwisting rate; contrast echocardiography to assess LV vortex morphology; and myocardial contrast echocardiography to identify the infarct size. Patients with a large infarct size LV segments) had a significantly lower VFT (p < 0.001) and vortex sphericity index (p <0.001). On univariate analysis, several variables were significantly related to the VFT, including anterior AMI, LV end-systolic volume, LV ejection fraction, grade of diastolic dysfunction, LV untwisting rate, and infarct size. On multivariate analysis, the LV untwisting rate (beta = -0.43, p <0.001) and infarct size (beta = -0.33, p = 0.005) were independently associated with VFT. In conclusion, early in AMI, both the LV infarct size and the mechanical sequence of diastolic restoration play key roles in modulating the morphology and dynamics of early diastolic vortex ring formation. (C) 2010 Elsevier Inc. All rights reserved. (Am J Cardiol 2010;106:1404-1409)Show less
model left-ventricle contrast echocardiography vortex formation flow quantification velocimetry doppler
All authors
Nucifora, G.; Delgado, V.; Bertini, M.; Marsan, N.A.; Veire, N.R. van de; Ng, A.C.T.; Siebelink, H.M.J.; Schalij, M.J.; Holman, E.R.; Sengupta, P.P.; Bax, J.J.
Date
2010-11-15
Journal
American Journal of Cardiology
Volume
106
Issue
10
Pages
1404 - 1409
DOI
doi:10.1016/j.amjcard.2010.06.072