Benefit of late coronary reperfusion on ventricular morphology and function after myocardial infarction

Cardiac Unit, Massachusetts General Hospital, Boston.

OBJECTIVES. This study was designed to examine the relation between the timing and adequacy of perfusion of the infarct bed and changes in ventricular size and the extent of abnormal wall motion after acute myocardial infarction. METHODS. A validated echocardiographic mapping technique was used to measure the left ventricular endocardial surface area index and the extent of abnormal wall motion over a 3-month period in 91 patients who had either 1) no anterograde or collateral flow to the infarct bed (n = 14), 2) only collateral flow to the infarct bed (n = 18), 3) restoration of anterograde flow to the infarct bed within hours of chest pain (early [n = 43]), or 4) restoration of anterograde flow to the infarct bed within a mean of 5 days after acute myocardial infarction (late [n = 16]). RESULTS. Over the follow-up period, a progressive and significant increase in endocardial surface area index was observed only in the group of patients without anterograde or collateral flow to the infarct bed (entry 64 +/- 3.4 cm2/m2 vs. 3 months 75.9 +/- 6.4 cm2/m2, p < 0.005). In contrast, a progressive reduction in the extent of abnormal wall motion was evident in the group of patients in whom anterograde flow to the infarct bed was restored within hours (entry 26.7 +/- 2.5 cm2 vs. 3 months 11.8 +/- 2.9 cm2, p < 0.001) or days (entry 22.1 +/- 3.6 cm2 vs. 3 months 11.8 +/- 3.3 cm2, p < 0.001) of coronary occlusion. Multiple stepwise linear regression analysis confirmed that by 3 months, 1) ventricular size was independently related to endocardial surface area index and abnormal wall motion at entry (p < 0.0001) and to the change in abnormal wall motion over the follow-up period (p < 0.0001), and 2) the change in abnormal wall motion was related to the presence of anterograde flow to the infarct bed (p < 0.0001) independent of the timing of reperfusion, infarct site or the extent of abnormal wall motion on admission. CONCLUSIONS. After myocardial infarction, the process of ventricular remodeling is influenced by changes in the extent of abnormal wall motion, which in turn are related to the adequacy rather than the timing of perfusion of the infarct bed.

This article has been cited by other articles:

				N. Tran, P. R. Franken, F. Maskali, J. Nloga, P. Maureira, S. Poussier, F. Groubatch, C. Vanhove, J.-P. Villemot, and P.-Y. Marie Intramyocardial Implantation of Bone Marrow-Derived Stem Cells Enhances Perfusion in Chronic Myocardial Infarction: Dependency on Initial Perfusion Depth and Follow-up Assessed by Gated Pinhole SPECT J. Nucl. Med., March 1, 2007; 48(3): 405 - 412. [Abstract] [Full Text] [PDF]

				O. A. Centurion The Open Artery Hypothesis: Beneficial Effects and Long-term Prognostic Importance of Patency of the Infarct-Related Coronary Artery Angiology, February 1, 2007; 58(1): 34 - 44. [Abstract] [PDF]

				M. Prech, S. Grajek, A. Marszalek, M. Lesiak, M. Jemielity, A. Araszkiewicz, T. Mularek-Kubzdela, and A. Cieslinski Chronic infarct-related artery occlusion is associated with a reduction in capillary density. Effects on infarct healing Eur J Heart Fail, June 1, 2006; 8(4): 373 - 380. [Abstract] [Full Text] [PDF]

				P. J de Kam, A. A Voors, F. Fici, D. J van Veldhuisen, and W. H van Gilst Review: The revised role of ACE-inhibition after myocardial infarction in the thrombolytic/primary PCI era Journal of Renin-Angiotensin-Aldosterone System, December 1, 2004; 5(4): 161 - 168. [Abstract] [PDF]

				K. Nakamura, S. Hirohata, T. Murakami, T. Miyoshi, K. Demircan, T. Oohashi, H. Ogawa, K. Koten, K. Toeda, S. Kusachi, et al. Dynamic Induction of ADAMTS1 Gene in the Early Phase of Acute Myocardial Infarction J. Biochem., October 1, 2004; 136(4): 439 - 446. [Abstract] [Full Text] [PDF]

				J. Cortadellas, J. Figueras, M. Missorici, E. Domingo, J. Rodes, J. Castell, and J. Soler Soler ST segment elevation at 72 hours in patients with a first anterior myocardial infarction best correlates with pre-discharge and 1-year regional contractility and ventricular dilatation Eur. Heart J., February 1, 2004; 25(3): 224 - 231. [Abstract] [Full Text] [PDF]

				F. W. Bowen, S. C. Jones, N. Narula, M. G. St. John Sutton, T. Plappert, L. H. Edmunds Jr, and I. M.C. Dixon Restraining acute infarct expansion decreases collagenase activity in borderzone myocardium Ann. Thorac. Surg., December 1, 2001; 72(6): 1950 - 1956. [Abstract] [Full Text] [PDF]

				F. W. Bowen, T. Hattori, N. Narula, I. S. Salgo, T. Plappert, M. G. St. John Sutton, and L. H. Edmunds Jr Reappearance of myocytes in ovine infarcts produced by six hours of complete ischemia followed by reperfusion Ann. Thorac. Surg., June 1, 2001; 71(6): 1845 - 1855. [Abstract] [Full Text] [PDF]

				L. H. Michael, C. M. Ballantyne, J. P. Zachariah, K. E. Gould, J. S. Pocius, G. E. Taffet, C. J. Hartley, T. T. Pham, S. L. Daniel, E. Funk, et al. Myocardial infarction and remodeling in mice: effect of reperfusion Am J Physiol Heart Circ Physiol, August 1, 1999; 277(2): H660 - H668. [Abstract] [Full Text] [PDF]

				S. T. Kelley, R. Malekan, J. H. Gorman III, B. M. Jackson, R. C. Gorman, Y. Suzuki, T. Plappert, D. K. Bogen, M. G. St. J. Sutton, and L. H. Edmunds Jr Restraining Infarct Expansion Preserves Left Ventricular Geometry and Function After Acute Anteroapical Infarction Circulation, January 12, 1999; 99(1): 135 - 142. [Abstract] [Full Text] [PDF]

				K. C. Wu, R. J. Kim, D. A. Bluemke, C. E. Rochitte, E. A. Zerhouni, L. C. Becker, and J. A. C. Lima Quantification and time course of microvascular obstruction by contrast-enhanced echocardiography and magnetic resonance imaging following acute myocardial infarction and reperfusion J. Am. Coll. Cardiol., November 15, 1998; 32(6): 1756 - 1764. [Abstract] [Full Text] [PDF]

				K. C. Wu, E. A. Zerhouni, R. M. Judd, C. H. Lugo-Olivieri, L. A. Barouch, S. P. Schulman, R. S. Blumenthal, and J. A. C. Lima Prognostic Significance of Microvascular Obstruction by Magnetic Resonance Imaging in Patients With Acute Myocardial Infarction Circulation, March 3, 1998; 97(8): 765 - 772. [Abstract] [Full Text] [PDF]

				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]

				F. Nijland, O. Kamp, F. W.A. Verheugt, G. Veen, and C. A. Visser Long-term Implications of Reocclusion on Left Ventricular Size and Function After Successful Thrombolysis for First Anterior Myocardial Infarction Circulation, January 7, 1997; 95(1): 111 - 117. [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]

				G. L. Nicolosi Cardiac Remodelling and Failure after Myocardial Infarction European Journal of Cardiovascular Prevention & Rehabilitation, December 1, 1994; 1(4): 310 - 313. [Abstract] [PDF]