EARLY ECHOCARDIOGRAPHIC CHANGES IN LEFT VENTRICULAR FUNCTION FOLLOWING PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY FOR ANTERIOR WALL MYOCARDIAL INFARCTION

Abstract

Background: Timely restoration of epicardial coronary flow after anterior wall myocardial infarction is expected to limit infarct size and preserve left ventricular function, but the echocardiographic changes occurring in the first few days after isolated left anterior descending artery revascularisation are less well described. We assessed early changes in left ventricular systolic and diastolic function after percutaneous transluminal coronary angioplasty and compared patients reperfused within and beyond 12 hours of symptom onset. Methods: In this prospective observational study, 50 consecutive adults with acute anterior wall ST-segment elevation myocardial infarction underwent successful angioplasty of an isolated left anterior descending lesion. Transthoracic echocardiography was performed within 24 hours before the procedure and repeated on the third day. Paired comparisons were made for the whole cohort and separately for early (≤12 h) and late (>12 h) presenters. Results: Left ventricular ejection fraction rose from 39.08 ± 11.19% to 44.29 ± 8.81% (p = 0.004), accompanied by a reduction in end-systolic diameter from 39.20 ± 6.51 to 36.25 ± 5.50 mm (p = 0.004), whereas the reduction in end-diastolic diameter from 50.95 ± 5.20 to 49.09 ± 5.43 mm was not statistically significant (p = 0.092). Peak early (E) and late (A) transmitral velocities both increased (p < 0.001), whereas the E/A ratio showed no significant change, from 0.994 ± 0.59 to 0.96 ± 0.52 (p = 0.484). E/e′ decreased from 11.28 ± 5.22 to 9.49 ± 3.69 (p = 0.029). Although some parameters showed numerically different magnitudes of change between early and late presenters, none of the between-group differences was statistically significant. Conclusions: Successful angioplasty of an isolated left anterior descending lesion was followed by improvement in systolic function and by changes in diastolic filling within three days. Early echocardiographic recovery was observed in both groups, with no statistically significant difference in the magnitude of change between early and late presenters.