Clinical Validity of Longitudinal Pre-Ejectional Myocardial Velocity for Identifying the Transmural Extent of Viable Myocardium

Early After Reperfusion of an Infarct-Related Coronary Artery

Abstract

Background Positive longitudinal pre-ejectional velocity (+PEV_L) was recently reported to be a reliable index of myocardial recovery early after successful revascularization in myocardial infarction (MI); that is, it recognizes the transmural extent of viable myocardium. The applicability of PEV_L in the real-world clinical setting for identifying the transmural extent of viable myocardium in reperfused recent MI was assessed. Methods and Results Using tissue Doppler imaging, the resting basal and mid myocardial PEV_Ls were determined within 3 days after revascularization in 41 consecutive patients with recent MI. Infarct thickness was semi-quantified using delayed gadolinium-enhanced magnetic resonance imaging (MRI) at baseline and at 6-month follow up to differentiate transmural from nontransmural MI. The proportion of segments showing the presence of +PEV_L was not significantly changed as infarct thickness increased (p=0.2), with 66.2% having +PEV_L even in segments involving >75% transmural infarction. Moreover, +PEV_L was found in a large fraction of segments with akinesia (70.4%). Specificity and negative predictive value of +PEV_L for assessing infarct nontransmurality were disappointingly low (32.0% and 26.9%, respectively). All of these results were not altered when the 6-month follow-up MRI was done. Conclusions +PEV_L cannot be regarded as a reliable marker for predicting the transmural extent of viable myocardium in recent MI. (Circ J 2007; 71: 1904 - 1911)