The effect of early postinfarction revascularization of asymptomatic patients on left ventricular remodeling

Dangas, George; Ambrose, John A.; Sharma, Samin K.; Shao, John; Feldman, Dmitriy N.; Cohen, Adam Max; Marmur, Jonathan D.; Cocke, Thomas; Duvvuri, Srinivas; Goldman, Martin E.

doi:10.1097/00019501-199906000-00001

Cited by 6 publications

(2 citation statements)

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“…Absence of remodelling was demonstrated after revascularisation of totally occluded infarct related arteries, whereas left ventricular dilatation was observed in patients with patent though stenosed infarct related arteries. 28 In our study, the occurrence of inducible ischaemia during DSE after uncomplicated myocardial infarction clearly identified patients with left ventricular enlargement at six months, and with a higher risk of major end diastolic volume increase (> 15 ml/m 2 ) (fig 3).…”

Section: Inducible Ischaemia and Remodellingsupporting

confidence: 58%

Influence of contractile reserve and inducible ischaemia on left ventricular remodelling after acute myocardial infarction

Coletta

Sestili²,

Seccareccia³

et al. 2003

Heart

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Objective: To assess the relative influence of contractile reserve and inducible ischaemia on subsequent left ventricular volume changes after myocardial infarction. Design: Left ventricular end diastolic and end systolic index volumes were calculated prospectively at discharge and at six months in 143 patients referred for early postinfarction dobutamine stress echocardiography. On the basis of their responses to this test, patients were divided into three groups: scar (n = 48; group 1); contractile reserve (n = 36; group 2); inducible ischaemia (n = 59; group 3). Results: At six months, the left ventricular end diastolic index volume decreased in group 2 (mean (SD), −3.9 (9.4) ml/m 2 ) and increased in both group 1 (+2.8 (10.6) ml/m 2 , p = 0.009 v group 2) and group 3 (+7.5 (11.4) ml/m 2 , p < 0.0001 v group 2). The end systolic index volume decreased in group 2 (−4.9 (7.3) ml/m 2 ) and increased in both group 1 (+1.3 (8.3) ml/m 2 , p = 0.0015 v group 2) and group 3 (+2.8 (8.9) ml/m 2 , p = 0.0002 v group 2). In multivariate analysis, the contractile reserve (hazard ratio 0.19, 95% confidence interval (CI) 0.14 to 0.47), inducible ischaemia (5.86, 95% CI 1.54 to 29.7), and end systolic index volume at discharge (1.04, 95% CI 0.99 to 1.11) were independent predictors of an increase in end diastolic index volume of > 15 ml/m 2 at six months. Conclusions: Contractile reserve and inducible ischaemia, as detected by early dobutamine stress echocardiography, identify patients with differences in long term left ventricular remodelling after acute myocardial infarction.T he development of left ventricular dilatation following myocardial infarction is the main finding in the complex process named ventricular remodelling, and it is one of the major determinants of a poor outcome.1 In previous studies, left ventricular remodelling occurred in patients with a larger infarct size 2 3 and with persistent occlusion of the infarct related artery. [4][5][6] Moreover, the transmural extent of necrosis and the presence of surviving myocardium within the infarct area were found, respectively, to be directly and inversely related to the early infarct zone expansion process. [7][8][9] The presence of viable myocytes-generally located in the outer layers of the ventricular wall and in the peripheral areas of the infarct area-may therefore contribute to preventing left ventricular enlargement by limiting infarct expansion.Few studies have investigated the influence of postinfarction contractile reserve on left ventricular volume changes. The favourable effect of infarct zone viability on left ventricular enlargement, as detected by early dobutamine stress echocardiography (DSE), has been shown in a population with successful primary coronary angioplasty, 10 and the relative role of contractile reserve, inducible ischaemia, and their combination on left ventricular postinfarct dilatation has recently been investigated.11 However, definitive data on patients with their first uncomplicated myocardial infarction treated by a conservativ...

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Section: Inducible Ischaemia and Remodellingsupporting

confidence: 58%

Influence of contractile reserve and inducible ischaemia on left ventricular remodelling after acute myocardial infarction

Coletta

Sestili²,

Seccareccia³

et al. 2003

Heart

View full text Add to dashboard Cite

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“…The effect of IRA reopening is still debated, the benefits demonstrated in previous studies have not been proved unequivocally in clinical practice [9–12,21]. While some authors reported a significant improvement in the LV function following coronary angioplasty performed several days or even weeks after MI others demonstrated no beneficial effects or an even worse outcome, related to a high rate of peri‐procedural complications that might offset potential benefits [33–37].…”

Section: Limitations Of the Studymentioning

confidence: 99%

Chronic infarct‐related artery occlusion is associated with a reduction in capillary density. Effects on infarct healing

Prech

Grajek

Marszałek

et al. 2006

European J of Heart Fail

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Aim: To assess the relationship between infarct-related artery (IRA) stenosis and capillary density and to assess its effect on scar formation in the human heart. Materials and methods: Morphometric evaluation was performed in 51 human hearts, as follows. Group I non-cardiac death (control), Group II post-Q-wave myocardial infarction (QMI) death and Group III patients who survived QMI and who underwent aneurysmectomy. Using morphometric parameters, the relationship between left ventricle (LV) mass, infarct size, IRA stenosis, cellular hypertrophy and changes in microcirculation were analyzed within the infarcted area and free LV wall. Results: A significant reduction in capillary density within the infarcted area was noted in group II when compared to the control group (1525.6 T 378.5/mm 2 vs. 2968.7 T 457.3/mm 2 ; p < 0.001). Reduction in capillary density was inversely related to infarct size (r = À 0.616; p = 0.006) and degree of IRA stenosis (r S = À 0.512; p = 0.03). The most significant reduction in capillary density was observed in patients with total IRA occlusion (1204.6 T 156.9/mm 2 vs. 1676.6 T 245.8/mm 2 ; p < 0.001). Similarly, a reduction in capillary density of over 60% (1030.7 T 241.8/mm 2 ) was observed within aneurysms resected surgically. Conclusions:The study demonstrated precise quantification of the capillary network in patients following QMI. The most significant reduction in capillary density was observed in patients with chronic total IRA occlusion.

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Value of myocardial contrast echocardiography for predicting left ventricular remodeling and segmental functional recovery after anterior wall acute myocardial infarction

Caldas

Tsutsui

Kowatsch

et al. 2004

Journal of the American Society of Echocardiography

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The effect of early postinfarction revascularization of asymptomatic patients on left ventricular remodeling

Cited by 6 publications

References 0 publications

Influence of contractile reserve and inducible ischaemia on left ventricular remodelling after acute myocardial infarction

Influence of contractile reserve and inducible ischaemia on left ventricular remodelling after acute myocardial infarction

Chronic infarct‐related artery occlusion is associated with a reduction in capillary density. Effects on infarct healing

Value of myocardial contrast echocardiography for predicting left ventricular remodeling and segmental functional recovery after anterior wall acute myocardial infarction

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