Increased Hyperkinesis in Noninfarcted Areas during Short-term Follow-up in Patients with First Anterior Acute Myocardial Infarction Treated by Direct Percutaneous Transluminal Coronary Angioplasty

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The time course and clinical significance of hyperkinetic wall motion(HWM) in a noninfarcted area in direct percutaneous transluminal coronary angioplasty(PTCA) has not been clearly demonstrated in patients with acute myocardial infarction(AMI). The objectives of this study were to examine the change in HWM during one-month follow-up after direct PTCA and determine its impact on the recovery of global left ventricular function. A total of 61 patients with first anteroseptal AMI and one vessel disease were evaluated. The paired left ventriculograms in the 30° right anterior oblique view taken both at baseline and follow-up were analyzed by the centerline and area length methods. The severity of hypokinesis was expressed by mean regional wall motion (standard deviation/chord) in most hypocontractile 50% of chords respondable to left anterior descending coronary artery area and HWM by mean regional wall motion in most hypercontractile 50% of chords of noninfarcted area. HWM increased from 0.18±1.07 to 0.48±1.30 (p=0.0608). The delta global ejection fraction (global ejection fraction at follow-up minus global ejection fraction at baseline) was correlated with both delta infarcted wall motion (infarcted wall motion at follow-up minus infarcted wall motion at baseline) and delta HWM (HWM at follow-up minus HWM at baseline) (r=0.576, p<0.0001, r=0.383, p=0.0036, respectively) during follow-up. Further, the delta global ejection fraction showed better correlation with delta (HWM + infarcted wall motion) [(HWM plus infarcted wall motion at follow-up) minus (HWM plus infarcted wall motion at baseline)] (r=0.593, p<0.0001). Direct PTCA resulted in the enhancement of HWM, which contributed to the increase in the global ejection fraction with the recovery of infarcted wall motion.