A Prospective Observational Study on Echocardiographic Assessment of Left Ventricular Diastolic Dysfunction in Patients with Anterior Wall Myocardial Infarction Post Revascularization

Dr. Anudeep Aveleli, Dr. Mohini Banerjee, Dr. Gnanaguru Durairaj

Abstract: Introduction: Diastolic Function are described as the rate and duration of the left ventricular pressure drop after systole and compliance, which is determined by volume changes over pressure changes during diastolic filling.LV diastolic function can be diagnosed noninvasively using two-dimensional and Doppler echocardiography. Three aberrant LV filling patterns are found based on Doppler study of mitral and pulmonary venous flow: poor relaxation, "pseudo normalization," and restrictive patterns. Myocardial ischemia causes abnormal myocardial relaxation that can be restored to normal by restoring normal myocardial blood flow. With the aid of mitral and pulmonary venous flow analysis, the diastolic anomaly can be detected within a matter of seconds and is accompanied by a distinctively defective relaxation filling pattern. In which Diastolic dysfunction is known to exist with or without LV systolic failure, diastolic dysfunction has been identified in the early as well as the post-MI phase. Both an aberrant relaxation pattern and a restrictive LV filling pattern are evident in the acute phase. Diastolic dysfunction in acute anterior wall MI is a common complication that can significantly impact patient outcomes. Diastolic dysfunction occurs prior to Systolic dysfunction according to systemic Cascade. Aim and Objectives: A prospective observational study, to assess Left Ventricular Diastolic dysfunction using 2D echocardiography in patients with revascularized Acute Anterior wall MI. Materials and Methods: A total of 120 patients who presented with acute anterior wall MI has been assessed for Left Ventricular diastolic dysfunction after Revascularization by using 2D echocardiography. Results: Out of 120 patients,44 patients were in Group 1 having Grade 1 and Grade 2 Diastolic dysfunction and 76 patients were in Group 2 having Grade 3 and Grade 4 diastolic dysfunction. This showed higher number individuals 63.3% have severe Diastolic Dysfunction (elevated filling pressure (E/A ratio), reduced tissue Doppler E/e? ratio, IVRT and reduced S/D ratio), following a revascularized MI. Conclusion: LV diastolic function evaluation is crucial in acute MI assessment. Doppler echocardiography provides key parameters, Mitral inflow E/A ratio, Tissue Doppler E/e', Isovolumetric relaxation time, Deceleration time. These parameters help stratify patients' risk of MI. Furthermore, LV diastolic dysfunction is common in acute MI patients, even after successful percutaneous coronary intervention (PCI). Diastolic dysfunction significantly increases MI risk, with higher grades of dysfunction associated with greater risk. Accurate assessment of LV diastolic function is essential for identifying patients at higher risk of adverse outcomes.

Keywords: AMI, Acute myocardial infarction, AWMI, Anterior wall myocardial infarction, DD, Diastolic dysfunction, IVRT, Isovolumetric relaxation time S/D ratio, Systolic to diastolic ratio. PASP, Pulmonary artery systolic pressure