Improvement in regional wall motion after percutaneous transluminal coronary angioplasty during acute myocardial infarction: utility of two-dimensional echocardiography.

In the setting of acute myocardial infarction, 16 patients undergoing successful coronary angioplasty (PTCA) within 6 hours of presentation (group I) and eight patients receiving conventional medical therapy (group II) were studied by serial two-dimensional (2D) echocardiography to assess the functional recovery of myocardium. All patients underwent 2D echocardiograms within 24 hours of presentation and at a minimum of 6 days after admission. Wall motion analysis was quantified with a wall motion score index based on 16 left ventricular wall segments. Wall motion score index improved significantly from early to late echocardiographic study in the patients undergoing PTCA (1.65 +/- 0.29 to 1.40 +/- 0.30; p less than 0.001), whereas the index did not improve in the conventionally treated group (1.54 +/- 0.26 to 1.58 +/- 0.25; p = NS). One patient in group II had a greater than or equal to 10% improvement in wall motion score index compared to 11 of 16 in group I (p less than 0.01). In all cases improvement in wall motion score index was due to improvement in regional wall motion in the area of infarction. In group I, 40 of 77 (52%) infarct zone segments showed improvement of at least one grade, versus 4 of 28 (14%) segments in group II (p less than 0.001). These data indicate that regional myocardial function improves in the majority of patients undergoing successful PTCA as emergency therapy for acute myocardial infarction and that serial 2D echocardiography is an excellent means to quantify this improvement.