Transmural contractile reserve after reperfused myocardial infarction in dogs

OBJECTIVES The goal of this study was to characterize detailed transmural left ventricular (LV) function at rest and during dobutamine stimulation in subendocardial and transmural experimental infarcts. BACKGROUND The relation between segmental LV function and the transmural extent of myocardial necrosis is complex. However, its detailed understanding is crucial for the diagnosis of myocardial viability as assessed by inotropic stimulation. METHODS Short-axis tagged magnetic resonance images were acquired at five to seven levels encompassing the LV from base to apex in seven dogs 2 days after a 90-min closed-chest left anterior descending coronary occlusion, followed by reflow. Myocardial strains were measured transmurally in the entire LV by harmonic phase imaging at rest and 5 ig.kg 21 .min 21 dobutamine. Risk regions were assessed by radioactive microspheres, and the transmural extent of the infarct was assessed by 2,3,5 triphenyltetrazolium chloride staining. RESULTS Circumferential shortening (Ecc), radial thickening (Err) and maximal shortening at rest were greater in segments with subendocardial versus transmural infarcts, both in subepicardium (21.1 6 1.0 vs. 2.5 6 0.6% for Ecc, 20.5 6 1.9 vs. 21.8 6 1.0% for Err, p , 0.05) and subendocardium (22.0 6 1.4 vs. 2.8 6 0.8%, 2.4 6 1.7 vs. 0.0 6 0.9%, respectively, p , 0.05). Under inotropic stimulation, risk regions retained maximal contractile reserve. Recruitable deformation was found in outer layers of subendocardial infarcts (p , 0.01 for Ecc and Err) but also in inner layers (p , 0.01). Conversely, no contractile reserve was observed in segments with transmural infarcts. CONCLUSIONS Under dobutamine challenge, recruitment of myofiber shortening and thickening was observed in inner layers of segments with subendocardial infarcts. These results may have important clinical implications for the detection of myocardial viability. (J Am Coll Cardiol 2000;36:2339 ‐ 46) © 2000 by the American College of Cardiology