Infarct artery perfusion and changes in left ventricular volume in the month after acute myocardial infarction

• Published in: Journal of the American College of Cardiology 1987-05, Vol.9 (5), p.989-995
• Main Authors: Jeremy, Richmond W., Hackworthy, Rosemary A., Bautovich, George, Hutton, Brian F., Harris, Phillip J.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Arteries - physiopathology; Biological and medical sciences; Blood Volume; Cardiology. Vascular system; Coronary heart disease; Female; Heart; Heart - physiopathology; Heart Ventricles - physiopathology; Humans; Male; Medical sciences; Middle Aged; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - physiopathology; Radionuclide Imaging; Statistics as Topic; Stroke Volume; Time Factors
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/S0735-1097(87)80298-X

The relation between perfusion of the infarct-related artery and changes in left ventricular volume and function during the month after a first myocardial infarction was examined in 40 patients who did not receive thrombolytic therapy. Infarct artery perfusion was documented at predischarge coronary angiography, and left ventricular volume was measured by nongeometric analysis of radionuclide angiograms performed within 48 hours of infarction and at 1 month. Left ventricular dilation (≥20% increase in volume) developed in 16 patients, whereas 5 patients had a decrease in left ventricular volume of ≥20% by 1 month. Left ventricular dilation occurred in all 14 patients without perfusion of the infarct-related artery, compared with only 2 of 26 patients with perfusion of this artery due to subtotal occlusion or collateral vessels. All five patients whose left ventricular volume decreased by ≥20% had a perfused infarct artery. Multiple linear regression analysis confirmed that the degree of perfusion of the infarct artery (partial r = 0.58, p = 0.001) was a more important predictor of volume change than was infarct size measured by peak creatine kinase (partial r = 0.30, p = 0.009) or QRS score (partial r = 0.20, p = 0.087). Left ventricular ejection fraction decreased from 0.38 ± 0.10 to 0.30 ± 0.16 (p = 0.05) in 11 patients with an anterior infarct and ventricular dilation; it increased from 0.45 ± 0.10 to 0.62 ± 0.07 (p = 0.02) in the 5 patients with a ≥20% decrease in volume. The degree of perfusion of the infarct-related artery at predischarge angiography is an important predictor of change in left ventricular volume in the month after infarction, independently of infarct size. Absent perfusion of the infarct artery is associated with the development of left ventricular dilation and impaired left ventricular function.