PMID- 30611651 OWN - NLM STAT- MEDLINE DCOM- 20200622 LR - 20200622 IS - 1878-0938 (Electronic) IS - 1878-0938 (Linking) VI - 20 IP - 11 DP - 2019 Nov TI - Disparate Impact of Ischemic Injury on Regional Wall Dysfunction in Acute Anterior vs Inferior Myocardial Infarction. PG - 965-972 LID - S1553-8389(18)30619-5 [pii] LID - 10.1016/j.carrev.2018.12.016 [doi] AB - BACKGROUND: Acute transmural ischemia should induce similar magnitude of wall motion abnormality (WMA) in both anterior myocardial infarction (AMI) and inferior (IMI). However, patients with AMI generally suffer more severe hemodynamic compromise. METHODS: This retrospective study compared WMA's in ST segment elevation MI patients undergoing primary reperfusion and subsequent cardiac MRI. Regional systolic wall motion and thickening were assessed in all segments throughout the left ventricle (LV). RESULTS: We analyzed 37 patients (AMI = 24 vs IMI = 13). Reperfusion success was achieved in all and there were no differences between groups in door-to-balloon time (AMI median 77 vs IMI 119 min, p = 0.085). Compared to IMI, in AMI LV ejection fraction was more depressed (37 +/- 7.6% vs 51 +/- 10.3%, P = 0.0006) and regional WMA more severe (total regional WMA score = 2.63 +/- 0.53 vs IMI = 2.1 +/- 0.52, P = 0.007). Regional dyskinesis was commonly observed in AMI patients but was rare in IMI (79% vs 7% of cases). Similarly, AMI manifested systolic thinning, whereas thickening was depressed but still present in IMI patients. Strikingly, WMA severity differed downstream relative to the origin of the infarct artery: In all AMI cases, WMA worsened from proximal anterior toward the distal apical zone; in IMI the pattern was reverse, with WMA consistently most severe in the basal segment of the inferior-posterior wall with preservation toward the apical distribution of the infarct vessel. CONCLUSION: These results demonstrate a disparate impact of ischemic injury on mechanical performance of the anterior vs inferior-posterior walls. These findings may be attributable to differences between the walls in architecture, mechanics and coronary blood flow. These observations may have implications for myocardial salvage, remodeling and prognosis. CI - Copyright (c) 2018 Elsevier Inc. All rights reserved. FAU - Feldmann, Kyle J AU - Feldmann KJ AD - Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, MI, USA. FAU - Goldstein, James A AU - Goldstein JA AD - Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, MI, USA. Electronic address: james.goldstein@beaumont.edu. FAU - Marinescu, Victor AU - Marinescu V AD - Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, MI, USA. FAU - Dixon, Simon R AU - Dixon SR AD - Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, MI, USA. FAU - Raff, Gilbert L AU - Raff GL AD - Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, MI, USA. LA - eng PT - Comparative Study PT - Journal Article DEP - 20181221 PL - United States TA - Cardiovasc Revasc Med JT - Cardiovascular revascularization medicine : including molecular interventions JID - 101238551 SB - IM CIN - Cardiovasc Revasc Med. 2019 Nov;20(11):1031. PMID: 31523000 MH - Aged MH - Anterior Wall Myocardial Infarction/diagnostic imaging/*physiopathology/therapy MH - Female MH - Humans MH - Inferior Wall Myocardial Infarction/diagnostic imaging/*physiopathology/therapy MH - Magnetic Resonance Imaging MH - Male MH - Middle Aged MH - *Percutaneous Coronary Intervention/adverse effects MH - Recovery of Function MH - Retrospective Studies MH - ST Elevation Myocardial Infarction/diagnostic imaging/*physiopathology/therapy MH - *Stroke Volume MH - Treatment Outcome MH - Ventricular Dysfunction, Left/diagnostic imaging/*physiopathology MH - *Ventricular Function, Left OTO - NOTNLM OT - Acute ST segment elevation myocardial infarction OT - Anterior ischemia OT - Cardiac magnetic resonance imaging OT - Dyskinesis OT - Inferior ischemia OT - Regional wall motion abnormality EDAT- 2019/01/07 06:00 MHDA- 2020/06/23 06:00 CRDT- 2019/01/07 06:00 PHST- 2018/11/26 00:00 [received] PHST- 2018/12/19 00:00 [accepted] PHST- 2019/01/07 06:00 [pubmed] PHST- 2020/06/23 06:00 [medline] PHST- 2019/01/07 06:00 [entrez] AID - S1553-8389(18)30619-5 [pii] AID - 10.1016/j.carrev.2018.12.016 [doi] PST - ppublish SO - Cardiovasc Revasc Med. 2019 Nov;20(11):965-972. doi: 10.1016/j.carrev.2018.12.016. Epub 2018 Dec 21.