Left ventricular remodeling after acute myocardial infarction: the influence of viability and revascularization - an echocardiographic substudy of the VIAMI-trial

Abstract

BackgroundViability seems to be important in preventing ventricular remodeling after acute myocardial infarction (AMI). We investigated the influence of viability, as demonstrated with low-dose dobutamine echocardiography, and the role of early revascularization on the process of left ventricular (LV) remodeling after AMI.MethodsWe retrospectively investigated 224 patients who were initially included in the viability-guided angioplasty after acute myocardial infarction-trial (VIAMI-trial). Patients in the VIAMI-trial did not undergo a primary or rescue percutaneous coronary intervention and were stable in the early in-hospital phase. Patients underwent viability testing within 72 hours after AMI. Patients with viability were randomized to an invasive strategy or an ischemia-guided strategy. Follow-up echocardiography was performed at a mean of 205 days. In this echocardiographic substudy, patients were divided into three new groups: group 1, viable and revascularized before follow-up echocardiogram; group 2, viable, but medically treated; and group 3, non-viable patients.ResultsGroup 1 showed preservation of LV volume indices. The ejection fraction (EF) increased significantly from 54.0% to 57.5% (P = 0.047). Group 2 showed a significant increase in LV volume indices with no improvement in EF (53.3% versus 53.0%, P = 0.86). Group 3 showed a significant increase in LV volume indices, with a decrease in EF from 53.5% to 49.1% (P = 0.043). Multivariate logistic regression analysis indicated the number of viable segments and revascularization during follow-up as independent predictors for EF improvement, especially in patients with lower EF at baseline.ConclusionViability early after AMI is associated with improvement in LV function after revascularization. When viable myocardium is not revascularized, the LV tends to remodel with increased LV volumes, without improvement of EF. Absence of viability results in ventricular dilatation and deterioration of EF, irrespective of revascularization status.Trial registrationNCT00149591 (assigned: 6 September 2005).Electronic supplementary materialThe online version of this article (doi:10.1186/1745-6215-15-329) contains supplementary material, which is available to authorized users.

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.…”

Detection of Left Ventricular Remodeling in Acute ST Elevation Myocardial Infarction after Primary Percutaneous Coronary Intervention by Two Dimensional and Three Dimensional Echocardiography

“…The left ventricular dilatation, as well as the reduction in the ejection fraction of the LV and the functional class represent important factors of poor prognosis, related to the heart failure after AMI. [ 13 ]…”

Perfusion Computed Tomography for the Assessment of Myocardial Viability — a Case Series

“…In this process of remodeling, an important role is played by myocardial viability, which has been demonstrated to be associated not only with a lower amplitude of the remodeling process, but also with a major regression following revascularization. 1 After an acute myocardial infarction, the identification of stunned myocardium has a major importance, because it represents the area of viable myocardium that can recover its function if a therapeutic intervention is done in order to improve myocardial perfusion, mainly consisting of interventional revascularization. A ne-crotic myocardium, where there is no evidence of viability, is an inert tissue and it does not respond well to therapeutic measurements.…”