Old myocardial infarct: echocardiographic study

• Published in: Giornale italiano di cardiologia Vol. 27; no. 8; p. 811
• Main Authors: Butera, A, Pelaggi, P, Palmieri, G L, Ferlaino, G
• Format: Journal Article
• Language: Italian
• Published: Italy 01.08.1997
• Subjects: Aged; Aged, 80 and over; Cardiomyopathies - diagnostic imaging; Cardiomyopathies - physiopathology; Diastole; Echocardiography; Female; Heart Aneurysm - diagnostic imaging; Heart Aneurysm - physiopathology; Humans; Male; Middle Aged; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - physiopathology; Myocardial Infarction - therapy; Systole; Thrombolytic Therapy; Thrombosis - diagnostic imaging; Thrombosis - physiopathology; Time Factors
• ISSN: 0046-5968

A large number of patients survives many years after an acute myocardial infarction (AMI). Echocardiographic study in patients with a very old myocardial infarction (VOMI) can certainly contribute to a better understanding of anatomical and functional damage of the heart. To describe the echocardiographic pattern and to analyze differences between patients with anterior (ant.) and inferior (inf.) VOMI and subjects treated or not with a thrombolytic agent (T+ and T-). METHODS, DESIGN OBSERVATIONAL STUDY: We performed an M-B mode and color-doppler echocardiographic examination of 136 patients (M/F: 130/6), mean age 64.4 +/- 9 years, with an isolated VOMI that is least 5 years old (mean 9.5 +/- 3.1; range 5-16 years), with a good visualization of left ventricular (lv) endocardial profile and without left bundle branch block or valvulopathy is related to myocardial infarction. We established electrocardiographic site and thrombolytic treatment on a documental basis dating from AMI. End diastolic volume index (EDVi), end systolic volume index (ESVi), ejection fraction (EF), wall motion score index (WMSI), left atrial antero-posterior diameter (AD) and presence of any lv aneurysm, scar, thrombus, mitral regurgitation (MR) were assessed. Data were compared with those of 100 normal subjects (controls) with sex, age and physical settlement similar to those of the patients. EDVi appeared much more enlarged in patients than in controls (p < 0.0001). There was a large difference between ant. VOMI and inf. VOMI (p < 0.0001); where as a smaller increase was noticed in T+ versus (vs) T- patients (p = 0.04). In comparison with controls, a smaller difference was observed in inf. VOMI (p = 0.002). ESVi presented a similar behaviour in patients vs controls and ant. vs inf. VOMI (p < 0.0001), but there was no statistical difference between T+ and T- while a large difference was detected between inf. VOMI and controls (p < 0.0001). EF was lower in patients than in controls (p < 0.0001) and in ant. VOMI rather than in inf. VOMI (p < 0.0001); no statistically relevant difference was seen between T+ and T-, while a large difference was observed between inf. VOMI and controls (p < 0.0001). WMSI appeared to be significantly worse in patients vs controls (p < 0.0001), but there was also a great difference between ant. and inf. VOMI (p < 0.0001). T+ had a better index in comparison with T- (p = 0.02). There was also large difference between inf. VOMI and controls (p < 0.0001). AD was larger in patients than in controls (p < 0.0001), but there was no statistical difference between ant. and inf. VOMI and T+ and T-; in comparison with controls, smaller difference was seen in inf. VOMI (p = 0.04). Aneurysm was seen in 16% of patients, more prevalently in ant. (27%) than in inf. VOMI (5%) (p < or = 0.001). Scarring was seen in 45% of patients and, like aneurysms, more in ant. (69%) than in inf. VOMI (22%) (p < or = 0.001). Thrombus was rarely detected (5%) and only in ant. VOMI (12%) with aneurism (p < or = 0.01 vs inf.). MR was seen in a large number of patients (48%) and in 27% of controls (p < or = 0.001). No significant difference was pointed out between ant. and inf. VOMI. Aneurysm, thrombus and MR (21.8 and 55% respectively) were more prevalent in T- than in T+ (9.3 and 48% respectively), with no statistical significance. Scarring prevailed in T+ (48%) rather than in T- (43%), without any statistical difference. Patients with VOMI show increased lv volumes, decreased EF and persistence of regional wall motion abnormalities. Volumetric and kinetic modifications mainly involve ant. VOMI, but inf. VOMI also presents similar but smaller modifications. Left atrial dimensions also increase in VOMI. Aneurysms, scars, MR occur frequently; while the presence of thrombus is infrequent. Thrombolytic therapy appears to be a long-term protection from anatomical and functional damage. Echocardiography seems to be the ideal tech