Measurement of postsystolic shortening to assess viability and predict recovery of left ventricular function after acute myocardial infarction

OBJECTIVES We sought to determine whether left ventricular (LV) postsystoli c shortening in the region of acute myocardial infarction (MI) predicts fun ctional recovery after primary angioplasty. BACKGROUND Previous studies in experimental animals have shown that postsys tolic shortening during temporary coronary occlusion predicts functional re covery after reperfusion. METHODS Contrast ventriculography was performed on 35 patients with acute M I before and immediately after angioplasty, and one day, one month, three m onths and one year later. The centerline method was used to measure regiona l LV wall motion at end systole from all six ventriculograms as well as mot ion during isovolumic relaxation (motion(iso)) and postsystolic shortening from end systole until the end of contraction. The ventriculograms of 23 pa tients with normal anatomy were similarly analyzed. RESULTS Wall motion at end systole improved significantly from baseline to follow-up in the infarct region. Postsystolic shortening at baseline correl ated most closely with the recovery of wall motion at three months in patie nts with anterior infarction (r = 0.69, n = 25, p = 0.0001) but also with r ecovery at one month and one year. The correlation was slightly less powerf ul for motion(iso). Functional recovery could not be predicted from assessm ent of motion(iso) and postsystoiic shortening in patients with inferior in farction. CONCLUSIONS In patients with acute anterior MI, analysis of postsystolic sh ortening in the infarct region predicts the recovery of systolic LV functio n after reperfusion. Postsystolic shortening represents active contraction and indicates viable myocardium. (J Am Coll Cardiol 2000;35: 1842-9) (C) 20 00 by the American College of Cardiology.