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Left ventricular diastolic function following myocardial infarction

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Abstract

An acute myocardial infarction causes a loss of contractile fibers which reduces systolic function. Parallel to the effect on systolic function, a myocardial infarction also impacts diastolic function, but this relationship is not as well understood. The two physiologic phases of diastole, active relaxation and passive filling, are both influenced by myocardial ischemia and infarction. Active relaxation is delayed following a myocardial infarction, whereas left ventricular stiffness changes depending on the extent of infarction and remodeling. Interstitial edema and fibrosis cause an increase in wall stiffness which is counteracted by dilation. The effect on diastolic function is correlated to an increased incidence of adverse outcomes. Moreover, patients with comorbid conditions that are associated with worse diastolic function tend to have more adverse outcomes after infarction. There are currently no treatments aimed specifically at treating diastolic dysfunction following a myocardial infarction, but several new drugs, including aldosterone antagonists, may offer promise.

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References and Recommended Reading

  1. Weiss JL, Frederiksen JW, Weisfeldt ML: Hemodynamic determinants of the time-course of fall in canine left ventricular pressure. J Clin Invest 1976, 58:751–760.

    PubMed  CAS  Google Scholar 

  2. Bertrand ME, Lablanche JM, Fourrier JL, et al.: Left ventricular systolic and diastolic function during acute coronary artery balloon occlusion in humans. J Am Coll Cardiol 1988, 12:341–347.

    Article  PubMed  CAS  Google Scholar 

  3. Bronzwaer JG, De Bruyne B, Ascoop CA, Paulus WJ: Comparative effects of pacing-induced and balloon coronary occlusion ischemia on left ventricular diastolic function in man. Circulation 1991, 84:211–222.

    PubMed  CAS  Google Scholar 

  4. Simari RD, Bell MR, Schwartz RS, et al.: Ventricular relaxation and myocardial ischemia: a comparison of different models of tau during coronary angioplasty. Cathet Cardiovasc Diagn 1992, 25:278–284.

    Article  PubMed  CAS  Google Scholar 

  5. Carroll JD, Hess OM, Hirzel HO, Krayenbuehl HP: Exercise-induced ischemia: the influence of altered relaxation on early diastolic pressures. Circulation 1983, 67:521–528.

    PubMed  CAS  Google Scholar 

  6. Aoyagi T, Pouleur H, Van Eyll C, et al.: Wall motion asynchrony is a major determinant of impaired left ventricular filling in patients with healed myocardial infarction. Am J Cardiol 1993, 72:268–272.

    Article  PubMed  CAS  Google Scholar 

  7. Hess OM, Osakada G, Lavelle JF, et al.: Diastolic myocardial wall stiffness and ventricular relaxation during partial and complete coronary occlusions in the conscious dog. Circ Res 1983, 52:387–400.

    PubMed  CAS  Google Scholar 

  8. Marsch SC, Dalmas S, Philbin DM, et al.: Post-ischemic diastolic dysfunction. J Cardiothorac Vasc Anesth 1994, 8:611–617.

    Article  PubMed  CAS  Google Scholar 

  9. Raya TE, Gay RG, Lancaster L, et al.: Serial changes in left ventricular relaxation and chamber stiffness after large myocardial infarction in rats. Circulation 1988, 77:1424–1431.

    PubMed  CAS  Google Scholar 

  10. Broder MI, Cohn JN: Evolution of abnormalities in left ventricular function after acute myocardial infarction. Circulation 1972, 46:731–743.

    PubMed  CAS  Google Scholar 

  11. Diamond G, Forrester JS: Effect of coronary artery disease and acute myocardial infarction on left ventricular compliance in man. Circulation 1972, 45:11–19.

    PubMed  CAS  Google Scholar 

  12. Russell RO Jr, Hunt D, Rackley CE: Left ventricular hemodynamics in anterior and inferior myocardial infarction. Am J Cardiol 1973, 32:8–16.

    Article  PubMed  Google Scholar 

  13. Moraski RE, Russell RO Jr, Smith MK, Rackley CE: Left ventricular function in patients with and without myocardial infarction and one, two or three vessel coronary artery disease. Am J Cardiol 1975, 35:1–10.

    Article  PubMed  CAS  Google Scholar 

  14. Bardet J, Rocha P, Rigaud M, et al.: Left ventricular compliance in acute myocardial infarction in man. Cardiovasc Res 1977, 11:122–131.

    PubMed  CAS  Google Scholar 

  15. Smith M, Ratshin RA, Harrell FE Jr, et al.: Early sequential changes in left ventricular dimensions and filling pressure in patients after myocardial infarction. Am J Cardiol 1974, 33:363–369.

    Article  PubMed  CAS  Google Scholar 

  16. Bertrand ME, Rousseau MF, Lefebvre JM, et al.: Left ventricular compliance in acute transmural myocardial infarction in man. Eur J Cardiol 1978, 7(Suppl):179–193.

    PubMed  Google Scholar 

  17. Mann T, Brodie BR, Grossman W, McLaurin LP: Effect of angina on the left ventricular diastolic pressure-volume relationship. Circulation 1977, 55:761–766.

    PubMed  CAS  Google Scholar 

  18. Fletcher PJ, Pfeffer JM, Pfeffer MA, Braunwald E: Left ventricular diastolic pressure-volume relations in rats with healed myocardial infarction. Effects on systolic function. Circ Res 1981, 49:618–626.

    PubMed  CAS  Google Scholar 

  19. Hamosh P, Cohn JN: Left ventricular function in acute myocardial infarction. J Clin Invest 1971, 50:523–533.

    Article  PubMed  CAS  Google Scholar 

  20. Rahimtoola SH, Loeb HS, Ehsani A, et al.: Relationship of pulmonary artery to left ventricular diastolic pressures in acute myocardial infarction. Circulation 1972, 46:283–290.

    PubMed  CAS  Google Scholar 

  21. Kupper W, Bleifeld W, Hanrath P, et al.: Left ventricular hemodynamics and function in acute myocardial infarction: studies during the acute phase, convalescence and late recovery. Am J Cardiol 1977, 40:900–905.

    Article  PubMed  CAS  Google Scholar 

  22. Shell W, Peter T, Mickle D, et al.: Prognostic implications of reduction of left ventricular filling pressure in early transmural acute myocardial infarction. Am Heart J 1981, 102:335–340.

    Article  PubMed  CAS  Google Scholar 

  23. Kuecherer H, Ruffmann K, Kuebler W: Determination of left ventricular filling parameters by pulsed Doppler echocardiography: a noninvasive method to predict high filling pressures in patients with coronary artery disease. Am Heart J 1988, 116:1017–1021.

    Article  PubMed  CAS  Google Scholar 

  24. Pozzoli M, Capomolla S, Sanarico M, et al.: Doppler evaluations of left ventricular diastolic filling and pulmonary wedge pressure provide similar prognostic information in patients with systolic dysfunction after myocardial infarction. Am Heart J 1995, 129:716–725.

    Article  PubMed  CAS  Google Scholar 

  25. Cerisano G, Bolognese L, Buonamici P, et al.: Prognostic implications of restrictive left ventricular filling in reperfused anterior acute myocardial infarction. J Am Coll Cardiol 2001, 37:793–799.

    Article  PubMed  CAS  Google Scholar 

  26. Temporelli PL, Giannuzzi P, Nicolosi GL, et al.: Dopplerderived mitral deceleration time as a strong prognostic marker of left ventricular remodeling and survival after acute myocardial infarction: results of the GISSI-3 echo substudy. J Am Coll Cardiol 2004, 43:1646–1653.

    Article  PubMed  Google Scholar 

  27. Poulsen SH, Jensen SE, Egstrup K: Longitudinal changes and prognostic implications of left ventricular diastolic function in first acute myocardial infarction. Am Heart J 1999, 137:910–918.

    Article  PubMed  CAS  Google Scholar 

  28. Garcia-Rubira JC, Molano F, Espina A, et al.: Abnormal filling pattern of the left ventricle and outcome in acute myocardial infarction. Int J Cardiol 1997, 61:143–149.

    Article  PubMed  CAS  Google Scholar 

  29. Whalley GA, Gamble GD, Doughty RN: Restrictive diastolic filling predicts death post acute myocardial infarction: a meta-analysis of prospective studies. Heart 2006; [Epub ahead of print]. A meta-analysis of echocardiographic studies of severe diastolic dysfunction following myocardial infarction. Describes prevalence and prognostic value.

  30. Nagueh SF, Middleton KJ, Kopelen HA, et al.: Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol 1997, 30:1527–1533.

    Article  PubMed  CAS  Google Scholar 

  31. Sohn DW, Chai IH, Lee DJ, et al.: Assessment of mitral annulus velocity by Doppler tissue imaging in the evaluation of left ventricular diastolic function. J Am Coll Cardiol 1997, 30:474–480.

    Article  PubMed  CAS  Google Scholar 

  32. Ho CY, Solomon SD: A clinician’s guide to tissue Doppler imaging. Circulation 2006, 113:e396-e398.

    Article  PubMed  Google Scholar 

  33. Ommen SR, Nishimura RA, Appleton CP, et al.: Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: a comparative simultaneous Doppler-catheterization study. Circulation 2000, 102:1788–1794.

    PubMed  CAS  Google Scholar 

  34. Hillis GS, Moller JE, Pellikka PA, et al.: Noninvasive estimation of left ventricular filling pressure by E/e’ is a powerful predictor of survival after acute myocardial infarction. J Am Coll Cardiol 2004, 43:360–367.

    Article  PubMed  Google Scholar 

  35. Hillis GS, Ujino K, Mulvagh SL, et al.: Echocardiographic indices of increased left ventricular filling pressure and dilation after acute myocardial infarction. J Am Soc Echocardiogr 2006, 19:450–456.

    Article  PubMed  Google Scholar 

  36. Aikawa Y, Rohde L, Plehn J, et al.: Regional wall stress predicts ventricular remodeling after anteroseptal myocardial infarction in the Healing and Early Afterload Reducing Trial (HEART): an echocardiography-based structural analysis. Am Heart J 2001, 141:234–242.

    Article  PubMed  CAS  Google Scholar 

  37. Aguilar D, Solomon SD, Kober L, et al.: Newly diagnosed and previously known diabetes mellitus and 1-year outcomes of acute myocardial infarction: the Valsartan in Acute Myocardial Infarction (VALIANT) Trial. Circulation 2004, 110:1572–1578.

    Article  PubMed  Google Scholar 

  38. Solomon SD, Sutton MSJ, Lamas GA, et al.: Ventricular remodeling does not accompany the development of heart failure in diabetic patients after myocardial infarction. Circulation 2002, 106:1251–1255.

    Article  PubMed  Google Scholar 

  39. Moller JE, Hillis GS, Oh JK, et al.: Left atrial volume: a powerful predictor of survival after acute myocardial infarction. Circulation 2003, 107:2207–2212. Demonstrates the strong prognostic value of left atrial volume shortly after myocardial infarction. Underlines the importance of antecedent left ventricular diastolic dysfunction in patients who suffer a myocardial infarction.

    Article  PubMed  Google Scholar 

  40. Kenchaiah S, Pfeffer MA, St. John Sutton M, et al.: Effect of antecedent systemic hypertension on subsequent left ventricular dilation after acute myocardial infarction (from the Survival and Ventricular Enlargement trial). Am J Cardiol 2004, 94:1–8.

    Article  PubMed  Google Scholar 

  41. van Heerebeek L, Borbely A, Niessen HW, et al.: Myocardial structure and function differ in systolic and diastolic heart failure. Circulation 2006, 113:1966–1973.

    Article  PubMed  Google Scholar 

  42. Dong SJ, Hees PS, Siu CO, et al.: MRI assessment of LV relaxation by untwisting rate: a new isovolumic phase measure of tau. Am J Physiol Heart Circ Physiol 2001, 281:H2002-H2009.

    PubMed  CAS  Google Scholar 

  43. Aurigemma GP, Gaasch WH: Clinical practice. Diastolic heart failure. N Engl J Med 2004, 351:1097–1105. A review of the clinical aspects of patients with heart failure with predominantly diastolic dysfunction. Focuses on diagnosis and treatment.

    Article  PubMed  CAS  Google Scholar 

  44. Moller JE, Brendorp B, Ottesen M, et al.: Congestive heart failure with preserved left ventricular systolic function after acute myocardial infarction: clinical and prognostic implications. Eur J Heart Fail 2003, 5:811–819.

    Article  PubMed  Google Scholar 

  45. Janardhanan R, Daley WL, Naqvi TZ, et al.: Rationale and design: the VALsartan In Diastolic Dysfunction (VALIDD) Trial: evolving the management of diastolic dysfunction in hypertension. Am Heart J 2006, 152:246–252.

    Article  PubMed  CAS  Google Scholar 

  46. Pitt B, Remme W, Zannad F, et al.: Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med 2003, 348:1309–1321. A large, randomized trial of an aldosterone antagonist in patients with low ejection fraction and heart failure following a myocardial infarction. There was a significant reduction in all-cause mortality.

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Scott D. Solomon MD.

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Thune, J.J., Solomon, S.D. Left ventricular diastolic function following myocardial infarction. Curr Heart Fail Rep 3, 170–174 (2006). https://doi.org/10.1007/s11897-006-0018-6

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