Document Detail


Heterogeneous fate of perfusion and contraction after anterior wall acute myocardial infarction and effects on left ventricular remodeling.
MedLine Citation:
PMID:  9874047     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
After acute myocardial infarction, patency of infarct vessel and extent of left venticular (LV) dysfunction are major determinants of ventricular remodeling. Spontaneous, delayed reperfusion in the infarct zone occurs in a sizeable number of patients well after the subacute phase. The aim of this study was to determine the relation between the occurrence of this spontaneous, delayed reperfusion and LV remodeling. In 84 patients, resting LV volumes, topography, regional function, and perfusion were quantitatively evaluated by 2-dimensional echocardiography and sestamibi tomography 5 weeks (study 1) and 7 months (study 2) after anterior Q-wave infarction. At study 2, LV end-diastolic volume increased by > 15% in 17 patients (20%, LV remodeling); they had already had at study 1 significantly larger LV volumes, more severe hypoperfusion and wall motion abnormalities, and greater regional dilation than patients with stable LV volumes. Delayed reperfusion occurred in 8 of 17 patients with and in 42 of 67 patients without LV remodeling (47% vs 63%; p=NS). At study 2, LV regional dilation and end-diastolic volumes were stable in patients with, but increased in patients without, spontaneous reperfusion (from 25+/-24% to 29+/-26% at study 2 [p<0.05] and from 65+/-14 to 68+/-18 ml/m2 [p <0.05]). At multivariate analysis, however, regional ventricular dilation at study 1 was the sole predictor of further LV remodeling. Thus, after acute myocardial infarction, spontaneous reperfusion occurring after 5 weeks plays only a minor role in influencing LV remodeling. Benefits from delayed reperfusion seem limited to patients with preserved LV volumes; patients with an enlarged left ventricle 5 weeks after acute infarction are prone to further LV remodeling, irrespective of delayed reperfusion.
Authors:
C Marcassa; M Galli; R Bolli; P L Temporelli; R Campini; P Giannuzzi
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The American journal of cardiology     Volume:  82     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  1998 Dec 
Date Detail:
Created Date:  1999-01-19     Completed Date:  1999-01-19     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1457-62     Citation Subset:  AIM; IM    
Affiliation:
Cardiology Division, Salvatore Maugeri Foundation IRCCS, Medical Institute of Rehabilitation of Veruno, Italy. cdl@intercom.it
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MeSH Terms
Descriptor/Qualifier:
Adult
Coronary Angiography
Coronary Circulation*
Echocardiography
Humans
Male
Middle Aged
Multivariate Analysis
Myocardial Infarction / physiopathology*
Predictive Value of Tests
Prospective Studies
Radiopharmaceuticals / diagnostic use
Technetium Tc 99m Sestamibi / diagnostic use
Time Factors
Ventricular Dysfunction, Left / diagnosis*,  physiopathology*
Ventricular Remodeling*
Chemical
Reg. No./Substance:
0/Radiopharmaceuticals; 109581-73-9/Technetium Tc 99m Sestamibi

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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