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Infarct resorption, compensatory hypertrophy, and differing patterns of ventricular remodeling following myocardial infarctions of varying size

David S. Fieno, PhD^*, Hanns B. Hillenbrand, MD^*, Wolfgang G. Rehwald, PhD^*, Kathleen R. Harris, BA^*, Robert S. Decker, PhD^*, Michele A. Parker, MS^*, Francis J. Klocke, MD, MACC^*,*, Raymond J. Kim, MD, FACC^* and Robert M. Judd, PhD^*

^* Feinberg Cardiovascular Research Institute, Chicago, Illinois, USA
Biomedical Engineering, Chicago, Illinois, USA
Medicine, The Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA

View larger version (45K): [in a new window]   Figure 1 Parameters used to assess circumferential changes in infarct territory over time. Expansion index = x/y (measured from the midpoints of the papillary muscles); thinning ratio = a/b; endocardial infarct length = Sen; epicardial infarct length = Sep; mean radial infarct thickness = infarct area (solid area)/ Sen.

View larger version (119K): [in a new window]   Figure 2 Two- and four-chamber long-axis magnetic resonance images and base-to-apex short-axis images in an animal studied three days after coronary occlusion. The anterior ventricular wall shows a nearly transmural area of increased signal intensity (infarction). (Field of view 260 x 160 mm2, matrix 256 x 120.)

View larger version (29K): [in a new window]   Figure 3 Infarcted, noninfarcted, and total left ventricular (LV) mass versus time after infarction. Absolute values are shown in panel A. Panel B depicts relative changes over time; absolute values at three days (the initial values obtained in the study) were designated 100% and subsequent values expressed as percentages of the three-day values. (n = 5, 7, and 5 for 45-min, 90-min, and permanent occlusion groups, respectively, at 3, 10, and 28 days; n = 4, 4, and 3 for 45-min, 90-min, and permanent occlusion groups at 56 days) (a = p < 0.05 vs. day 3, b = p < 0.05 vs. day 10, c = p < 0.05 vs. day 28; x = p < 0.05 vs. 45-min occlusion, y = p < 0.05 vs. 90-min occlusion).

View larger version (139K): [in a new window]   Figure 4 Short-axis magnetic resonance images at three days and eight weeks after infarction illustrating infarct thinning with time.

View larger version (33K): [in a new window]   Figure 5 Mean infarct thickness, infarct thinning ratio, infarct expansion index, circumferential epicardial infarct arc length (Sep), long/short axis ratio, and end-diastolic volume as percentages of three-day values. Absolute values at three days averaged 9.3 ± 1.0 mm, 1.34 ± 0.06, 2.33 ± 0.25, 74 ± 3.1 mm, 1.42 ± 0.06 and 49 ± 3.4 ml, respectively. Solid lines = animals completing eight weeks; dashed lines = animals dying between four and eight weeks.

View larger version (78K): [in a new window]   Figure 6 Three-dimensional rendering of infarct size at three days and eight weeks in a permanently occluded animal. Green inner surface = left ventricular endocardium, wire mesh = epicardium, red = area of infarction. Infarct size decreased from 15 to 4 g while noninfarct mass increased from 65 to 74 g.

View larger version (22K): [in a new window]   Figure 7 Time-related histologic changes in cellular debris and connective tissue in areas of infarction, and in nucleus-to-cytoplasm ratio in remote non-infarcted myocardium. Data are normalized to three-day values. Open and closed circles = animals with 90-min and permanent occlusions, respectively.