Left ventricular remodeling in the year after first anterior myocardial infarction: a quantitative analysis of contractile segment lengths and ventricular shape

Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts 02115.

Infarct expansion after myocardial infarction results in early ventricular enlargement and distortion of ventricular geometry. To characterize the components of late volume enlargement, biplane left ventriculography was performed in 52 patients 3 weeks and 1 year after a first anterior myocardial infarction. Biplane diastolic circumference and contractile and noncontractile segment lengths were measured. Global geometry was evaluated by using a sphericity index (angiographic volume of the ventricle divided by the volume of a sphere with the same circumference). Regional geometry was assessed by measurement of endocardial curvature, an important determinant of wall tension. End-diastolic volume was enlarged at baseline and increased at 1 year (230 +/- 42 to 244 +/- 55 ml, p = 0.01) as a result of increases in contractile segment length (34 +/- 5 to 37 +/- 5 cm, p less than 0.001) and sphericity index (0.74 +/- 0.07 to 0.76 +/- 0.08, p less than 0.001), whereas the noncontractile segment length decreased (15 +/- 6 to 12 +/- 6 cm, p less than 0.005). Curvature analysis revealed a flattening of presumably high tension concavity at the anterobasal (-6.0 +/- 4.0 to -4.5 +/- 3.7, p less than 0.01) and inferior (-4.5 +/- 2.0 to -3.6 +/- 2.1, p less than 0.005) margins of the infarct and less bulging of the anterior wall (9.4 +/- 2.5 to 8.2 +/- 2.3, p less than 0.001). Patients selected for late enlargement (diastolic volume increase greater than 20 ml, n = 19) had an increase in sphericity (0.75 +/- 0.05 to 0.80 +/- 0.08, p less than 0.005) and in diastolic circumference (54 +/- 3 to 56 +/- 4 cm, p less than 0.001) secondary to elongation of the contractile segment (32 +/- 4 to 36 +/- 4 cm, p = 0.001) at 1 year. Thus, late ventricular enlargement after anterior infarction results from an increase in contractile segment length and a change in ventricular geometry and is not a result of progressive infarct expansion. In the group of patients at high risk for late ventricular enlargement because of persistent occlusion of the infarct-related vessel, captopril therapy attenuated late volume enlargement by preventing these changes in contractile segment length and chamber geometry.

This article has been cited by other articles:

				H. Subramanian, B. Kunadian, and J. Dunning Is it worth performing surgical ventricular restoration in patients with ischemic cardiomyopathy and akinetic but non-aneurysmal segments in the left ventricle? Interactive CardioVascular and Thoracic Surgery, August 1, 2008; 7(4): 702 - 707. [Abstract] [Full Text] [PDF]

				R. Beeri, C. Yosefy, J. L. Guerrero, F. Nesta, S. Abedat, M. Chaput, F. del Monte, M. D. Handschumacher, R. Stroud, S. Sullivan, et al. Mitral regurgitation augments post-myocardial infarction remodeling failure of hypertrophic compensation. J. Am. Coll. Cardiol., January 29, 2008; 51(4): 476 - 486. [Abstract] [Full Text] [PDF]

				A. Jacquier, C. B. Higgins, A. J. Martin, L. Do, D. Saloner, and M. Saeed Injection of Adeno-associated Viral Vector Encoding Vascular Endothelial Growth Factor Gene in Infarcted Swine Myocardium: MR Measurements of Left Ventricular Function and Strain Radiology, October 1, 2007; 245(1): 196 - 205. [Abstract] [Full Text] [PDF]

				M. Cimini, S. Fazel, S. Zhuo, M. Xaymardan, H. Fujii, R. D. Weisel, and R.-K. Li c-Kit Dysfunction Impairs Myocardial Healing After Infarction Circulation, September 11, 2007; 116(11_suppl): I-77 - I-82. [Abstract] [Full Text] [PDF]

				I. George, Y. Cheng, G.-H. Yi, K.-L. He, X. Li, M. C. Oz, J. Holmes, and J. Wang Effect of passive cardiac containment on ventricular synchrony and cardiac function in awake dogs Eur. J. Cardiothorac. Surg., January 1, 2007; 31(1): 55 - 64. [Abstract] [Full Text] [PDF]

				A. N. Mazzadi, X. Andre-Fouet, N. Costes, P. Croisille, D. Revel, and M. F. Janier Mechanisms leading to reversible mechanical dysfunction in severe CAD: alternatives to myocardial stunning Am J Physiol Heart Circ Physiol, December 1, 2006; 291(6): H2570 - H2582. [Abstract] [Full Text] [PDF]

				U. Sartipy, A. Albage, and D. Lindblom Risk factors for mortality and hospital re-admission after surgical ventricular restoration Eur. J. Cardiothorac. Surg., November 1, 2006; 30(5): 762 - 769. [Abstract] [Full Text] [PDF]

				T. Baks, R.-J. van Geuns, D. J. Duncker, F. Cademartiri, N. R. Mollet, G. P. Krestin, P. W. Serruys, and P. J. de Feyter Prediction of Left Ventricular Function After Drug-Eluting Stent Implantation for Chronic Total Coronary Occlusions J. Am. Coll. Cardiol., February 21, 2006; 47(4): 721 - 725. [Abstract] [Full Text] [PDF]

				N. S Anavekar and S. D Solomon Angiotensin II receptor blockade and ventricular remodelling Journal of Renin-Angiotensin-Aldosterone System, March 1, 2005; 6(1): 43 - 48. [Abstract] [PDF]

				J. X. Qin, T. Shiota, H. Tsujino, G. Saracino, R. D. White, N. L. Greenberg, J. Kwan, Z. B. Popovic, D. A. Agler, W. J. Stewart, et al. Mitral annular motion as a surrogate for left ventricular ejection fraction: real-time three-dimensional echocardiography and magnetic resonance imaging studies Eur J Echocardiogr, December 1, 2004; 5(6): 407 - 415. [Abstract] [Full Text] [PDF]

				E. Vanoli, S. Bacchini, S. Panigada, F. Pentimalli, and P. B Adamson Experimental models of heart failure Eur. Heart J. Suppl., November 1, 2004; 6(suppl_F): F7 - F15. [Abstract] [Full Text] [PDF]

				H. F.J Mannaerts, J. A van der Heide, O. Kamp, M. G Stoel, J. Twisk, and C. A Visser Early identification of left ventricular remodelling after myocardial infarction, assessed by transthoracic 3D echocardiography Eur. Heart J., April 2, 2004; 25(8): 680 - 687. [Abstract] [Full Text] [PDF]

				D. S.H. Bell Heart Failure: A Serious and Common Comorbidity of Diabetes Clin. Diabetes, April 1, 2004; 22(2): 61 - 65. [Abstract] [Full Text] [PDF]

				B. Westendorp, R. G Schoemaker, H. Buikema, D. de Zeeuw, D. J van Veldhuisen, and W. H van Gilst Dietary sodium restriction specifically potentiates left ventricular ACE inhibition by zofenopril, and is associated with attenuated hypertrophic response in rats with myocardial infarction Journal of Renin-Angiotensin-Aldosterone System, March 1, 2004; 5(1): 27 - 32. [Abstract] [PDF]

				D. S.H. Bell Heart Failure: The frequent, forgotten, and often fatal complication of diabetes Diabetes Care, August 1, 2003; 26(8): 2433 - 2441. [Abstract] [Full Text] [PDF]

				S. Delepine, A. P. Furber, F. Beygui, F. Prunier, P. Balzer, J.-J. Le Jeune, and P. Geslin 3-D MRI assessment of regional left ventricular systolic wall stress in patients with reperfused MI Am J Physiol Heart Circ Physiol, April 1, 2003; 284(4): H1190 - H1197. [Abstract] [Full Text] [PDF]

				N. Spyrou, S. D. Rosen, F. Fath-Ordoubadi, R. Jagathesan, R. Foale, J. S. Kooner, and P. G. Camici Myocardial beta-adrenoceptor densityone month after acute myocardial infarctionpredicts left ventricular volumes at six months J. Am. Coll. Cardiol., October 2, 2002; 40(7): 1216 - 1224. [Abstract] [Full Text] [PDF]

				Z. Yang, C. M. Bove, B. A. French, F. H. Epstein, S. S. Berr, J. M. DiMaria, J. J. Gibson, R. M. Carey, and C. M. Kramer Angiotensin II Type 2 Receptor Overexpression Preserves Left Ventricular Function After Myocardial Infarction Circulation, July 2, 2002; 106(1): 106 - 111. [Abstract] [Full Text] [PDF]

				I. Sheiban, G. Fragasso, G. M. C. Rosano, A. Dharmadhikari, V. Tzifos, P. Pagnotta, S. L. Chierchia, and G. Trevi Time course and determinants of left ventricular function recovery after primary angioplasty in patients with acute myocardial infarction J. Am. Coll. Cardiol., August 1, 2001; 38(2): 464 - 471. [Abstract] [Full Text] [PDF]

				S. Mankad, T. A. d'Amato, N. Reichek, W. E. McGregor, J. Lin, D. Singh, W. J. Rogers, and C. M. Kramer Combined Angiotensin II Receptor Antagonism and Angiotensin-Converting Enzyme Inhibition Further Attenuates Postinfarction Left Ventricular Remodeling Circulation, June 12, 2001; 103(23): 2845 - 2850. [Abstract] [Full Text] [PDF]

				C. L. Athanasuleas, A. W. H. Stanley Jr., G. D. Buckberg, V. Dor, M. DiDonato, E. H. Blackstone, and the RESTORE group Surgical anterior ventricular endocardial restoration (SAVER) in the dilated remodeled ventricle after anterior myocardial infarction J. Am. Coll. Cardiol., April 1, 2001; 37(5): 1199 - 1209. [Abstract] [Full Text] [PDF]

				M. J. W. Gotte, A. C. van Rossum, J. W. R. Twisk, J. P. A. Kuijer, J. T. Marcus, and C. A. Visser Quantification of regional contractile function after infarction: strain analysis superior to wall thickening analysis in discriminating infarct from remote myocardium J. Am. Coll. Cardiol., March 1, 2001; 37(3): 808 - 817. [Abstract] [Full Text] [PDF]

				J. X. Qin, M. Jones, T. Shiota, N. L. Greenberg, H. Tsujino, M. S. Firstenberg, P. C. Gupta, A. D. Zetts, Y. Xu, J. P. Sun, et al. Validation of real-time three-dimensional echocardiography for quantifying left ventricular volumes in the presence of a left ventricular aneurysm: in vitro and in vivo studies J. Am. Coll. Cardiol., September 1, 2000; 36(3): 900 - 907. [Abstract] [Full Text] [PDF]

				K. J. Osterziel, W. F. Blum, O. Strohm, and R. Dietz The Severity of Chronic Heart Failure due to Coronary Artery Disease Predicts the Endocrine Effects of Short- Term Growth Hormone Administration J. Clin. Endocrinol. Metab., April 1, 2000; 85(4): 1533 - 1539. [Abstract] [Full Text]

				J. N. Cohn, R. Ferrari, N. Sharpe, and on Behalf of an International Forum on Cardiac Rem Cardiac remodeling--concepts and clinical implications: a consensus paper from an international forum on cardiac remodeling J. Am. Coll. Cardiol., March 1, 2000; 35(3): 569 - 582. [Abstract] [Full Text] [PDF]

				C. M. Kramer, P. D. Nicol, W. J. Rogers, P. S. Seibel, C. S. Park, and N. Reichek beta -Blockade improves adjacent regional sympathetic innervation during postinfarction remodeling Am J Physiol Heart Circ Physiol, October 1, 1999; 277(4): H1429 - H1434. [Abstract] [Full Text] [PDF]

				A. Goussev, V. G. Sharov, H. Shimoyama, M. Tanimura, M. Lesch, S. Goldstein, and H. N. Sabbah Effects of ACE inhibition on cardiomyocyte apoptosis in dogs with heart failure Am J Physiol Heart Circ Physiol, August 1, 1998; 275(2): H626 - H631. [Abstract] [Full Text] [PDF]

				C. F. Opitz, P. V. Finn, M. A. Pfeffer, G. F. Mitchell, and J. M. Pfeffer Effects of reperfusion on arrhythmias and death after coronary artery occlusion in the rat: increased electrical stability independent of myocardial salvage J. Am. Coll. Cardiol., July 1, 1998; 32(1): 261 - 267. [Abstract] [Full Text] [PDF]

				I. S. Anand, D. Liu, S. S. Chugh, A. J.C. Prahash, S. Gupta, R. John, F. Popescu, and Y. Chandrashekhar Isolated Myocyte Contractile Function Is Normal in Postinfarct Remodeled Rat Heart With Systolic Dysfunction Circulation, December 2, 1997; 96(11): 3974 - 3984. [Abstract] [Full Text]

				K. McDonald, C. Chu, G. Francis, D. Judd, W. Carlyle, C. Toher, K. Hauer, and M. Hartman The effect of delayed reperfusion following infarction in the rat on structural changes in viable myocardium Cardiovasc Res, December 1, 1997; 36(3): 347 - 353. [Abstract] [Full Text] [PDF]

				M. St. J. Sutton, M. A. Pfeffer, L. Moye, T. Plappert, J. L. Rouleau, G. Lamas, J. Rouleau, J. O. Parker, M. O. Arnold, B. Sussex, et al. Cardiovascular Death and Left Ventricular Remodeling Two Years After Myocardial Infarction : Baseline Predictors and Impact of Long-term Use of Captopril: Information From the Survival and Ventricular Enlargement (SAVE) Trial Circulation, November 18, 1997; 96(10): 3294 - 3299. [Abstract] [Full Text]

				E. J. Eichhorn and M. R. Bristow Medical Therapy Can Improve the Biological Properties of the Chronically Failing Heart: A New Era in the Treatment of Heart Failure Circulation, November 1, 1996; 94(9): 2285 - 2296. [Abstract] [Full Text]

				C. M. Kramer, W. J. Rogers, T. M. Theobald, T. P. Power, S. Petruolo, and N. Reichek Remote Noninfarcted Region Dysfunction Soon After First Anterior Myocardial Infarction: A Magnetic Resonance Tagging Study Circulation, August 15, 1996; 94(4): 660 - 666. [Abstract] [Full Text]

				G. Melillo, J. A.C. Lima, R. M. Judd, P. J. Goldschmidt-Clermont, and H. S. Silverman Intrinsic Myocyte Dysfunction and Tyrosine Kinase Pathway Activation Underlie the Impaired Wall Thickening of Adjacent Regions During Postinfarct Left Ventricular Remodeling Circulation, April 1, 1996; 93(7): 1447 - 1458. [Abstract] [Full Text]

				G. A. Lamas, G. C. Flaker, G. Mitchell, S. C. Smith Jr, B. J. Gersh, C.-C. Wun, L. Moye, J. L. Rouleau, J. D. Rutherford, M. A. Pfeffer, et al. Effect of Infarct Artery Patency on Prognosis After Acute Myocardial Infarction Circulation, September 1, 1995; 92(5): 1101 - 1109. [Abstract] [Full Text]