Left Ventricular Remodeling After Primary Coronary Angioplasty

Abstract

Background-We prospectively evaluated the prevalence, pattern, and prognostic impact of left ventricular (LV) remodeling after acute myocardial infarction (AMI) successfully treated with primary PTCA. The prevalence, course, and prognostic value of LV remodeling after primary PTCA are still to be clarified. Methods and Results-In 284 consecutive patients with AMI treated with primary PTCA, serial echocardiographic and angiographic studies, within 24 hours (T1), at 1 (T2) and 6 months (T3) after AMI were performed. Long-term (61Ϯ14 months) clinical follow-up data were collected for 98.6% patients enrolled in the study. Overall, 85 (30%) patients showed LV dilation (Ͼ20% end-diastolic volume increase) at T3 as compared with T1. Early (from T1 to T2), late (from T2 to T3), and progressive dilation patterns (from T1 to T2 to T3) were detected in 42 (15%), 41 (14%), and 36 (13%) patients, respectively. Cardiac death and combined events rate was significantly higher among patients with than among those without LV dilation (Pϭ0.005 and Pϭ0.025, respectively). The pattern of LV dilation during 6 months did not significantly affect survival. Cox survival analysis identified end-systolic volume at T1 and age as baseline predictors and end-systolic volume at T3 and age as 6-month predictors of cardiac death, respectively. Conclusions-LV remodeling after successful PTCA occurs despite sustained patency of the infarct-related artery and preservation of regional and global LV function. LV dilation at 6 months after AMI but not the specific pattern of LV dilation is clearly associated with worse long-term clinical outcome.

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

“…We observed that infarct size and severity could be significant predictors of LV remodelling. Several clinical studies demonstrated that various parameters are predictive of remodelling, including anterior infarct location, patency of the infarctrelated artery, perfusion and functional parameters [4][5][6][7][8][9][10][11][12][13]. In agreement with these previous findings, the present study showed a number of baseline parameters predictive of remodelling, infarct severity demonstrating the best predictive value.…”

“…In disagreement with these data, studies exploring functional abnormalities by echocardiography [9,10] or the presence of Q waves on the electrocardiogram [11] indicated that infarct transmurality and the presence of residual viability in the infarct territory could be more important than the infarct size in influencing LV remodelling. The relation between infarct severity and LV functional outcome was also confirmed in gated SPECT studies, showing that infarct severity was more effective than infarct size for predicting subsequent LV remodelling [12,13].…”

Mitochondrial Integrity and Function in the Progression of Early Pressure Overload–Induced Left Ventricular Remodeling

“…The moderate (MOD) remodeling phenotype was defined as a LVEDV and/or LVESV that was >20% higher than the average value in sham. We used the 20% cutoff change in volume as a marker of more significant remodeling as previously described 14, 15…”

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

“…11 According to the presence or absence of LV dilatation at 6 months after infarction, patients were divided into an LV remodeling group or a no LV remodeling group, respectively. Successful PTCA was defined as the restoration of TIMI 3 grade flow and residual stenosis Ͻ30% at the end of the procedure.…”

“…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.…”