Influence of Infarct-Zone Viability on Left Ventricular Remodeling After Acute Myocardial Infarction

Bolognese, Leonardo; Cerisano, Giampaolo; Buonamici, Piergiovanni; Santini, Alberto; Santoro, Giovanni Maria; Antoniucci, David; Fazzini, Pier Filippo

doi:10.1161/01.cir.96.10.3353

Cited by 137 publications

(92 citation statements)

References 29 publications

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“…Since infarct severity is an expression of infarct transmurality and of viability within the infarcted area, this finding is in agreement with other observations about the influence of viability on LV remodelling [30].…”

Section: Discussionsupporting

confidence: 92%

Relationship of infarct size and severity versus left ventricular ejection fraction and volumes obtained from 99mTc-sestamibi gated single-photon emission computed tomography in patients treated with primary percutaneous coronary intervention

Sciagrà

Impériale

Antoniucci

et al. 2004

Eur J Nucl Med Mol Imaging

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Abstract. The current technique of choice for perfusion imaging is gated single-photon emission computed tomography (SPECT), which allows the simultaneous assessment of perfusion and left ventricular (LV) function. We examined the relationships of infarct size and severity with LV ejection fraction (EF) and volumes in 215 myocardial infarction patients treated with primary percutaneous coronary intervention within 6 h of symptom onset. Patients were studied with resting gated SPECT 1 month later. Infarct size was expressed as LV percent, and infarct severity as the lowest activity ratio within the defect. LVEF, end-diastolic (ED) and end-systolic (ES) volume indexes (Vi) were calculated with commercial software. There was a significant correlation between infarct size and LVEF (r=−0.68, P<0.00001), EDVi (r=0.53, P<0.00001), and ESVi (r=0.62, P<0.00001). Slightly lower correlations were demonstrated using infarct severity. LVEF and volumes were related to infarct location. A significantly higher correlation was observed between infarct size and LVEF in anterior than in non-anterior infarctions (r=−0.75 vs −0.60, P<0.05). In multivariate analysis, infarct size and infarct location were significant predictors of LVEF (R 2 =0.50) and ESV (R 2 =0.40). Infarct size and infarct severity were significant predictors of EDVi (R 2 =0.29). Infarct size (and severity) and LVEF (and volumes) derived from a single gated SPECT study correlate closely. Infarct location influences this relationship, with anterior infarctions showing a lower LVEF than inferior or lateral ones of the same extent.

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Section: Discussionsupporting

confidence: 92%

Relationship of infarct size and severity versus left ventricular ejection fraction and volumes obtained from 99mTc-sestamibi gated single-photon emission computed tomography in patients treated with primary percutaneous coronary intervention

Sciagrà

Impériale

Antoniucci

et al. 2004

Eur J Nucl Med Mol Imaging

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“…In each patient, an infarct-zone wallmotion score index (IZWMSI) was derived by averaging the scores from each segment within the area at risk. 9 LV volumes and ejection fraction were measured with the modified Simpson rule algorithm. 8 The mean value of 3 measurements of the technically best cardiac cycles was taken from each examination.…”

Section: Discussionmentioning

confidence: 99%

“…Intraobserver and interobserver variability values in the evaluation of end-diastolic volumes were Ͻ5%, which indicates the good reproducibility of the measurements. 9 Color Doppler of mitral regurgitation was graded with a 0 to 4 scale (0ϭnone, 1ϭmild, 2ϭmoderate, 3ϭmoderate to severe, and 4ϭsevere). 10 …”

Section: Discussionmentioning

confidence: 99%

“…11,12 Multiple factors may contribute to LV remodeling at different stages, from the time of coronary occlusion until the development of ventricular dilation and dysfunction. Infarct size, 13 anterior infarct location, 14 transmural extent of necrosis, 9 perfusional status of the IRA, 15 heart failure on admission, 16 and restrictive pattern of LV filling 17,18 have been identified as major predictors of LV dilatation after myocardial infarction in various patient populations. The importance of microvascular dysfunction by MCE complicating mechanical reperfusion after AMI as an additional major predictor of early LV remodeling has been suggested by recent studies.…”

Section: Microvascular Dysfunction and LV Remodelingmentioning

confidence: 99%

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Impact of Microvascular Dysfunction on Left Ventricular Remodeling and Long-Term Clinical Outcome After Primary Coronary Angioplasty for Acute Myocardial Infarction

et al. 2004

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Background-We hypothesized that preserved microvascular integrity in the area at risk would favorably influence left ventricular (LV) remodeling and long-term outcome after acute myocardial infarction. Methods and Results-Before and after successful primary angioplasty (percutaneous transluminal coronary angioplasty[PTCA]), 124 patients with acute myocardial infarction underwent intracoronary myocardial contrast echo (MCE). An MCE score index (MCESI) was derived by averaging the single-segment score (0ϭnot visible, 1ϭpatchy, 2ϭhomo-geneous contrast effect) within the area at risk. An MCESI Ն1 was considered adequate reperfusion. Mean follow-up was 46Ϯ32 months. After PTCA, 100 patients showed adequate reperfusion (no microvascular dysfunction, NoMD), whereas 24 did not (MD

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“…Volumetric data were corrected for body surface area and expressed as indexes (I). Remodelling was defined as an increase in LVEDVI at follow-up≥20% of the baseline value [19].…”

Section: Gated Spectmentioning

confidence: 99%

Relationship between infarct size and severity measured by gated SPECT and long-term left ventricular remodelling after acute myocardial infarction

Berti

Sciagrà

Acampa

et al. 2011

Eur J Nucl Med Mol Imaging

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Purpose After acute myocardial infarction (AMI), left ventricular (LV) remodelling may occur despite successful reperfusion. This study aimed to investigate by gated single photon emission computed tomography (SPECT) the longterm evolution of myocardial perfusion and LV function after AMI and to identify the predictors of LV remodelling. Methods Sixty-eight AMI patients successfully treated by primary percutaneous coronary intervention underwent 99m Tc-sestamibi gated SPECT at 1 month (baseline) and over 6-month follow-up after the acute event. LV remodelling was defined as 20% increase in LV end-diastolic volume at follow-up. Results At baseline, patients with remodelling (n=14) showed larger (infarct size 29.3±7.8%) and more transmural (infarct severity 0.28±0.10) infarctions, and reduced LV ejection fraction (35.4±5.6%), but similar LV volume indexes, compared to patients without remodelling (n=54) (infarct size 20.8±14.4%, p<0.05, infarct severity 0.40± 0.11, p<0.001, ejection fraction 44.5±9.2, p<0.001). At stepwise multivariate regression analysis, infarct severity showed the best predictive value for predicting LV remodelling (F = 5.54, p < 0.05). Using the thresholds identified by receiver-operating characteristic curve analysis, infarct size and severity detected patients with remodelling with 75% accuracy and 95% negative predictive value. Infarct resorption (defined as the defect size difference between follow-up and baseline) was comparable between patients with (−4.4±8.4%) and without remodelling (−6.8±9.4%) (p=NS). Conclusion Perfusion parameters assessed by gated SPECT in the subacute phase after successfully treated AMI correlate with changes in functional parameters at long-term followup. Infarct severity is more effective than infarct size, but both are helpful for predicting LV remodelling.

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Influence of Infarct-Zone Viability on Left Ventricular Remodeling After Acute Myocardial Infarction

Cited by 137 publications

References 29 publications

Relationship of infarct size and severity versus left ventricular ejection fraction and volumes obtained from 99mTc-sestamibi gated single-photon emission computed tomography in patients treated with primary percutaneous coronary intervention

Relationship of infarct size and severity versus left ventricular ejection fraction and volumes obtained from 99mTc-sestamibi gated single-photon emission computed tomography in patients treated with primary percutaneous coronary intervention

Impact of Microvascular Dysfunction on Left Ventricular Remodeling and Long-Term Clinical Outcome After Primary Coronary Angioplasty for Acute Myocardial Infarction

Relationship between infarct size and severity measured by gated SPECT and long-term left ventricular remodelling after acute myocardial infarction

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