Anteroapical aneurysm plication improves mechanical intraventricular dyssynchrony in patients with anterior myocardial infarction.

ABSTRACT

BACKGROUND: Left ventricular (LV) dyssynchrony has been described to occur in patients with myocardial infarction. Dyssynchrony of left ventricular mechanical contraction produces adverse hemodynamic consequences. This study aimed to test the capacity of geometric rebuilding by aneurysm plication to restore a more synchronous contractile pattern after a mechanical, rather than electrical, intervention. METHODS: A total of sixty patients with anterior myocardial infarction, QRS duration < 120 ms, electively undergoing operation between January 2008 and January 2010 were included for analysis. Real-time 3-dimensional echocardiography was performed to assess LV function, LV systolic and diastolic dyssynchrony by measuring ejection fraction (EF), peak ejection rate (PER), peak filling rate (PFR) and LV dyssynchrony. LV dyssynchrony was defined as the systolic dyssynchrony of the time to reach the minimum systolic volume for 16 LV segments, expressed in percent cardiac cycle, systolic dyssynchrony index (SDI). We compared changes of LV dyssynchrony at different interval times. RESULTS: LV contraction was significantly asynchronous because preoperative SDI was higher, EF, PER and PFR were lowered. Compared with function after operation, LV mechanical intraventricular resynchronization was improved with decreased SDI ((8.7 ± 0.5)% vs. (14.3 ± 1.6)%, P = 0.01); LV function was improved with EF increasing ((43 ± 9)% vs. (37 ± 7)%, P = 0.001), and LV systolic and diastolic dyssynchrony was improved with more rapid PFR (199.4 ± 15.6 vs. 148.4 ± 21.2, P = 0.002) and PER (212.4 ± 14.5 vs. 156.3 ± 26.2, P = 0.001). CONCLUSIONS: Systolic and diastolic dyssynchrony was highly prevalent in patients with aneurysm, irrespective of QRS duration. Aneurysm plication produces a mechanical intraventricular resynchronization.