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CLINICAL STUDY

Time course of cardiac structural, functional and electrical changes in asymptomatic patients after myocardial infarction: their inter-relation and prognostic impact

Peter Gaudron, MD^a, Ingrid Kugler, MD^a, Kai Hu, MD, Wolfgang Bauer, MD, Christoph Eilles, MD and Georg Ertl, MD

^a II.Medizinische Universitätsklinik, Klinikum Mannheim der Universität Heidelberg, Heidelberg, Germany
Medizinische Universitätsklinik Würzburg, Würzburg, Germany
Department of Nuclear Medicine, Universität Regensburg, Regensburg, Germany

Manuscript received March 15, 2000; revised manuscript received March 1, 2001, accepted March 23, 2001.

Reprint requests and correspondence: Dr. Georg Ertl, Medizinische Universitätsklinik, Universität Würzburg, Josef-Schneider Strasse 2, 97080 Würzburg, Germany
g.ertl{at}medizin.uni-wuerzburg.de

OBJECTIVES

We prospectively studied the relationship between left ventricular (LV) dilation, dysfunction, electrical instability and death in patients after a first myocardial infarction (MI) without symptoms of heart failure and ischemia.

BACKGROUND

Mechanisms linking LV dysfunction and sudden death in patients after MI remained controversial.

METHODS

Left ventricular volumes, hemodynamics, electrocardiogram and 24-h Holter recordings were sequentially obtained between two days and seven years after MI. Left ventricular catheterization and coronary angiography were performed, and revascularization was performed if appropriate.

RESULTS

Death occurred in 16 (12%) of the 134 patients included; it was of cardiac origin in 14 (88%) and sudden in origin in 12 (75%) patients. Of 37 (28%) patients with LV dilation, 12 died (32%); four patients (5.8%) died in the group without dilation. Left ventricular dilation was closely related to signs of electrical instability, as indicated by a significant correlation between end-diastolic LV volume index, Lown score (r = 0.98, p < 0.0001) and QTc prolongation (r = 0.998, p < 0.01), respectively.

CONCLUSIONS

Patients with progressive remodeling are at increased risk of sudden death in chronic MI. Cardiac electrical instability is closely related to progressive LV dilation. Parameters of electrical instability and remodeling are predictors of sudden death. The findings suggest that remodeling might serve as a link between dysfunction, electrical instability of the heart and sudden death after MI.

Abbreviations and Acronyms   ANP = atrial natriuretic peptide   BUN = blood urea nitrogen   ECG = electrocardiogram   LV = left ventricle/ventricular   MI = myocardial infarction   SDANN = standard deviation of the average NN interval   SDNN = standard deviation of the NN interval

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