Incidence, determinants, and prognostic value of reverse left ventricular remodelling after primary percutaneous coronary intervention: results of the Acute Myocardial Infarction Contrast Imaging (AMICI) multicenter study

Abstract

AimsFew data are available on the extent and prognostic value of reverse left ventricular remodelling (r-LVR) after ST-elevation acute myocardial infarction (STEMI). We sought to evaluate incidence, major determinants, and long-term clinical significance of r-LVR in a group of STEMI patients treated with primary percutaneous coronary intervention (PPCI). In particular, the role of preserved microvascular flow within the infarct zone in inducing r-LVR has been investigated.Methods and resultsSerial echocardiograms (2DE) and myocardial contrast study were obtained within 24 h of coronary recanalization (T1) and at pre-discharge (T2) in 110 reperfused STEMI patients. Follow-up 2DE was scheduled after 6 months (T3). Two-year clinical follow-up was obtained. Reverse remodelling was defined as a reduction >10% in LV end-systolic volume (LVESV) at 6 months follow-up. r-LVR occurred in 39% of study population. At multivariable analysis, independent predictors of r-LVR were an effective microvascular reflow within the infarct zone, the in-hospital improvement of myocardial perfusion, an initial large LVESV, and a short time to reperfusion. Cox analysis identified r-LVR as the only independent predictor of 2-year event-free survival. Combined events rate was significantly higher among patients without compared to those with r-LVR (log-rank test P < 0.05).Conclusionr-LVR frequently occurs in STEMI patients treated with PPCI and it is an important predictor of favourable long-term outcome. A preserved microvascular perfusion within the infarct zone is the major determinant of r-LVR.

The Course of Ischemic Mitral Regurgitation in Acute Myocardial Infarction After Primary Percutaneous Coronary Intervention

“…[8][9][10] The earlier the onset-toreperfusion time, the greater the degree of LV salvage can be expected, which results in prompt LV improvement and then chronic reverse remodeling of the LV. In the present study, we separately showed the dynamics of IMR in (1) the early stage and (2) the follow-up period after PCI as an effect of the emergency reperfusion.…”

“…Primary percutaneous coronary intervention (PCI) for AMI can provide dynamic improvement of left ventricular (LV) function, [8][9][10] which should dramatically affect the magnitude of IMR. Although some recent studies have reported the prognostic value of the IMR 11,12 or the effect of revascularization on the degree of IMR in patients who underwent PCI, [13][14][15][16][17] serial dynamics of IMR from the emergency room (ER) to followup period after PCI has yet to be investigated.…”

2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death

“…Dotyczy to zwłaszcza tych osób, u których przedoperacyjne badania obrazowe wskazywały na obecność niedokrwionego lub zahibernowanego mięśnia sercowego [291,292]. U większości pacjentów ze znacznym zmniejszeniem LVEF bezpośrednio po przebyciu STEMI obserwuje się istotną poprawę czynności skurczowej po 3 miesiącach [286].…”

Prevention of late postmyocardial infarction left ventricular remodeling: An update

“…Recently, the AMICI multicenter study showed that reverse remodeling frequently occurs in ST-segment elevation in MI patients treated with primary PCI and is an important predictor of favorable long-term outcome. A preserved microvascular perfusion within the infarct zone is the major determinant of reverse remodeling [75].…”