Infarct Size as Predictor of Systolic Functional Recovery after Myocardial Infarction

Background

The effects of modern therapy on functional recovery after acute myocardialinfarction (AMI) are unknown.

Objectives

To evaluate the predictors of systolic functional recovery after anteriorwall AMI in patients undergoing modern therapy (reperfusion, aggressiveplatelet antiaggregant therapy, angiotensin-converting enzyme inhibitors andbeta-blockers).

Methods

A total of 94 consecutive patients with AMI with ST-segment elevation wereenrolled. Echocardiograms were performed during the in-hospital phase andafter 6 months. Systolic dysfunction was defined as ejection fraction value< 50%.

Results

In the initial echocardiogram, 64% of patients had systolic dysfunction.Patients with ventricular dysfunction had greater infarct size, assessed bythe measurement of total and isoenzyme MB creatine kinase enzymes, thanpatients without dysfunction. Additionally, 24.5% of patients that initiallyhad systolic dysfunction showed recovery within 6 months after AMI. Patientswho recovered ventricular function had smaller infarct sizes, but largervalues of ejection fraction and E-wave deceleration time than patientswithout recovery. At the multivariate analysis, it can be observed thatinfarct size was the only independent predictor of functional recovery after6 months of AMI when adjusted for age, gender, ejection fraction and E-wavedeceleration time.

Conclusion

In spite of aggressive treatment, systolic ventricular dysfunction remains afrequent event after the anterior wall myocardial infarction. Additionally,25% of patients show functional recovery. Finally, infarct size was the onlysignificant predictor of functional recovery after six months of acutemyocardial infarction.