TRANSIENT LEFT-VENTRICULAR FILLING ABNORMALITIES (DIASTOLIC STUNNING) AFTER ACUTE MYOCARDIAL-INFARCTION

A variety of experimental studies suggest that diastolic left ventricular (LV) function changes after acute myocardial infarction (AMI), but limited data exist on these changes in humans. To assess diastolic filling after AMI, 60 patients underwent Doppler echocardiographic examination within 24 hours of AMI. Of 54 patients who also underwent catheterization, 45 (83%) were successfully reperfused. A subgroup of 17 patients underwent a follow-up Doppler examination at 7 days after infarction, whereas 15 patients with stable exertional angina served as control subjects. There was no significant difference in age, gender, incidence of systemic hypertension or diabetes mellitus, heart rate, mean arterial pressure or severity of coronary artery disease between the infarct and control groups. The infarct group had a lower velocity time integral total (9.9 ± 0.4 cm vs 12.0 ± 0.9 cm, p < 0.001), a lower velocity time integral E (5.8 ± 0.3 cm vs 6.8 ± 0.5 cm, p < 0.01) and a lower velocity time integral 0.333 (3.5 ± 0.4 cm vs 6.1 ± 0.5 cm, p < 0.01) than the control group. In addition, velocity time integral A/total was significantly greater in the infarction group (0.44 ± 0.03 vs 0.35 ± 0.04, p < 0.01) compared to the control group. The follow-up subgroup showed an increase in velocity time integral total (p < 0.01), velocity time integral E (p < 0.05) and velocity time integral 0.333/total (p < 0.05) over the first 7 days after infarction. The final recovery values at 7 days were not significantly different from those of the coronary artery disease group. Patients with initial ejection fractions <40% or anterior infarction had the greatest recovery during the 7-day period. In conclusion, LV filling is further impaired during acute infarction compared to patients with stable coronary artery disease with the predominant impairment in early diastole. After infarction, filling parameters improve over the first 7 days after AMI, suggesting a recovery of diastolic stunning. © 1990.