J Cardiovasc Ultrasound.  2016 Sep;24(3):208-214. 10.4250/jcu.2016.24.3.208.

Diastolic Dyssynchrony in Acute ST Segment Elevation Myocardial Infarction and Relationship with Functional Recovery of Left Ventricle

• Turan B
• DaÅŸli T
• Erkol A
• Erden I
• BaÅŸaran Y

• KMID: 2353098
• DOI: http://doi.org/10.4250/jcu.2016.24.3.208

Abstract

BACKGROUND
Incidence of diastolic dyssynchrony (DD) and its impact on functional recovery of left ventricle (LV) after ST segment elevation myocardial infarction (STEMI) is not known.
METHODS
Consecutive patients with STEMI who underwent successful revascularization were prospectively enrolled. Echocardiography with tissue Doppler imaging was performed within 48 hours of admission and at 6 months. LV end-diastolic volume index (EDVI), end-systolic volume index (ESVI), ejection fraction (EF), and left atrial volume index (LAVI) were calculated. Diastolic delay was calculated from onset of QRS complex to peak of E wave in tissue Doppler image and presented as maximal temporal difference between peak early diastolic velocity of 6 basal segments of LV (TeDiff). Study patients were compared with demographically matched control group.
RESULTS
Forty eight consecutive patients (55 ± 10 years, 88% male) and 24 controls (56 ± 6 years, 88% male) were included. TeDiff was higher in STEMI than in controls (35.9 ± 19.9 ms vs. 26.3 ± 6.8 ms, p = 0.025). Presence of DD was higher in STEMI than controls (58% vs. 33%, p = 0.046) according to calculated cut-off value (≥ 29 ms). There was no correlation between TeDiff and change in EDVI, ESVI, and LAVI at 6 months, however TeDiff and change in EF at 6 months was positively correlated (r = 0.328, p = 0.023). Patients with baseline DD experienced remodeling less frequently compared to patients without baseline DD (11% vs. 38%, p = 0.040) during follow-up.
CONCLUSION
STEMI disrupts diastolic synchronicity of LV. However, DD during acute phase of STEMI is associated with better recovery of LV thereafter. This suggests that DD is associated with peri-infarct stunned myocardium that is salvaged with primary intervention as well as infarct size.

Keyword

Diastolic dyssynchrony; Myocardial infarction; Remodeling

MeSH Terms

Echocardiography
Follow-Up Studies
Heart Ventricles*
Humans
Incidence
Myocardial Infarction*
Myocardial Stunning
Prospective Studies

Figure

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  Fig. 1 Maximal diastolic delay between 6 basal segments of LV (TeDiff) of controls, patients during and 6 months after STEMI. Bars indicate means and standard errors. LV: left ventricle, STEMI: ST segment elevation myocardial infarction.

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  Fig. 2 Correlation of TeDiff with % change in EDVI, ESVI, EF, and LAVI. TeDiff: maximal temporal difference between peak early diastolic velocity of 6 basal segments, EDVI: end-diastolic volume index, ESVI: end-systolic volume index, EF: ejection fraction, LAVI: left atrial volume index.

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  Fig. 3 Incidence of late remodeling according to presence of baseline diastolic dyssynchrony (TeDiff ≥ 29 ms). TeDiff: maximal temporal difference between peak early diastolic velocity of 6 basal segments.

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