Circulation, Vol 75, 1249-1260, Copyright © 1987 by American Heart Association
S Kaul, W Glasheen, TD Ruddy, NG Pandian, AE Weyman and RD Okada
Because the left ventricular "area at risk" is the most important
determinant of ultimate infarct size, it would be useful to know the size
of the area at risk during acute myocardial infarction to make therapeutic
decisions. We therefore performed a series of experiments in four groups of
dogs. In group I dogs (n = 15) we attempted to determine whether current
methods of assessing left ventricular function during acute myocardial
infarction reflect the true size of the area at risk. At each of two to
five sequential stages, a more proximal coronary occlusion was performed to
produce a larger area at risk until cardiovascular collapse occurred. At
each stage, the area at risk (measured by myocardial contrast
echocardiography), hemodynamic variables, and left ventricular ejection
fraction (LVEF) were measured. Hemodynamic variables became abnormal when
the area at risk was large (25% to 40% of the left ventricle), whereas LVEF
became abnormal when the area at risk was of moderate size (18%). When
cardiac output and LVEF were normalized to baseline values, a close inverse
relationship was noted between these variables and area at risk. In
contrast, there was a poor relationship between normalized mean arterial
pressure and area at risk (r = .42). In group II dogs (n = 9) the area at
risk was measured serially over 6 hr after coronary occlusion. The size of
the area at risk remained unchanged regardless of the transmural extent of
the ultimate infarct. The circumferential endocardial extent of the area at
risk closely predicted the circumferential endocardial extent of the
infarct at 6 hr in eight of nine dogs that developed an infarct. Group III
dogs (n = 7) underwent the same protocol as group II dogs, but the duration
of occlusion was 3 hr. The circumferential endocardial extent of the area
at risk closely predicted the circumferential endocardial extent of the
infarct. Group IV dogs (n = 5) underwent subtotal coronary occlusion.
Although regional wall motion abnormalities were noted in this group, no
area at risk could be defined. We conclude that although a close inverse
relationship is noted between normalized cardiac output and area at risk,
the absolute values for cardiac output and other hemodynamic variables
become abnormal only when the area at risk is large (25% to 40%);
measurement of LVEF may provide a better assessment of the size of the area
at risk than hemodynamic variables.(ABSTRACT TRUNCATED AT 400 WORDS)
ARTICLES
The importance of defining left ventricular area at risk in vivo during acute myocardial infarction: an experimental evaluation with myocardial contrast two-dimensional echocardiography
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