Document Detail

Left ventricular remodeling after late revascularization correlates with baseline viability.
MedLine Citation:
PMID:  25120390     Owner:  NLM     Status:  In-Data-Review    
The ideal management of stable patients who present late after acute ST-elevation myocardial infarction (STEMI) is still a matter of conjecture. We hypothesized that the extent of improvement in left ventricular function after successful revascularization in this subset was related to the magnitude of viability in the infarct-related artery territory. However, few studies correlate the improvement of left ventricular function with the magnitude of residual viability in patients who undergo percutaneous coronary intervention in this setting. In 68 patients who presented later than 24 hours after a confirmed first STEMI, we performed resting, nitroglycerin-enhanced, technetium-99m sestamibi single-photon emission computed tomography-myocardial perfusion imaging (SPECT-MPI) before percutaneous coronary intervention, and again 6 months afterwards. Patients whose baseline viable myocardium in the infarct-related artery territory was more than 50%, 20% to 50%, and less than 20% were divided into Groups 1, 2, and 3 (mildly, moderately, and severely reduced viability, respectively). At follow-up, there was significant improvement in end-diastolic volume, end-systolic volume, and left ventricular ejection fraction in Groups 1 and 2, but not in Group 3. We conclude that even late revascularization of the infarct-related artery yields significant improvement in left ventricular remodeling. In patients with more than 20% viable myocardium in the infarct-related artery territory, the extent of improvement in left ventricular function depends upon the amount of viable myocardium present. The SPECT-MPI can be used as a guide for choosing patients for revascularization.
Pravin K Goel; Tanuj Bhatia; Aditya Kapoor; Sanjay Gambhir; Prasanta K Pradhan; Sukanta Barai; Satyendra Tewari; Naveen Garg; Sudeep Kumar; Suruchi Jain; Ponnusamy Madhusudan; Siddegowda Murthy
Publication Detail:
Type:  Journal Article     Date:  2014-08-01
Journal Detail:
Title:  Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital     Volume:  41     ISSN:  1526-6702     ISO Abbreviation:  Tex Heart Inst J     Publication Date:  2014 Aug 
Date Detail:
Created Date:  2014-08-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8214622     Medline TA:  Tex Heart Inst J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  381-8     Citation Subset:  IM    
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