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Diastolic Dyssynchrony in Acute ST Segment Elevation Myocardial Infarction and Relationship with Functional Recovery of Left Ventricle
Burak Turan1*, Tolga Daşlı1, Ayhan Erkol1, İsmail Erden1, Yelda Başaran2
1Kocaeli Derince Training And Research Hospital Cardiology
2School of Medicine, Maramara University
Corresponding Author: Burak Turan ,Tel: +905056293509, Email: drburakturan@gmail.com
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 6 basal segments of LV (TeDiff). Study patients were compared with demographically matched control group. RESULTS: Forty eight consecutive patients (55±10years, 88% male) and 24 controls (56±6years, 88% male) were included. TeDiff was higher in STEMI than in controls (35.9±19.9 vs 26.3±6.8ms, p=0.025). Presence of DD was higher in STEMI than controls (58 vs 33%, p=0.046) according to calculated cut-off value (≥29ms). 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.
Keywords: Diastolic dyssynchrony, Myocardial infarction, Remodeling
Volume 25, No 3
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