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Hu M, Peng Y, Gao X, Yang J, Xu H, Wu Y, Song L, Qiao S, Hu F, Wang Y, Li W, Jin C, Yang Y. Coronary Intervention in ST-Segment Elevation Myocardial Infarction Patients With Symptom Onset >12 Hours: Data from China Acute Myocardial Infarction Registry. Angiology 2023; 74:171-180. [PMID: 35608524 DOI: 10.1177/00033197221098885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
To determine whether late percutaneous coronary intervention (PCI) of an infarct-related artery >12 h after ST-segment elevation myocardial infarction onset is beneficial, patients were included from the prospective, nationwide, multicenter China Acute Myocardial Infarction registry. The number of patients who underwent PCI or received drug therapy alone was 4791 and 1149, respectively. Hazard ratio (HR) and associated 95% confidence interval (CI) were calculated. Compared with drug therapy, PCI was associated with lower incidences of 2-year major adverse cardiac and cerebrovascular events (MACCE; 6.43 vs 20.19%; HR, .27; 95% CI, .23-.32; P < .001), all-cause death (4.13 vs 15.74%; HR, .24; 95% CI, .20-.30; P < .001), myocardial infarction (1.73 vs 3.31%; HR, .49; 95% CI, .33-.72; P = .0003), stroke (1.02 vs 2.00%; HR, .47; 95% CI, .28-.77; P = .0026), and revascularization (10.96 vs 27.56%; HR, .32; 95% CI, .26-.39; P < .001). Subgroup analysis consistently indicated that PCI was superior to drug therapy. Moreover, the left ventricular ejection fraction in the PCI group was increased after 2-year follow-up, whereas there was no significant increase in the drug therapy group. In conclusion, late PCI is common in Chinese clinical practice, and it is associated with significant improvements in cardiac function and survival compared with drug therapy alone.
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Affiliation(s)
- Mengjin Hu
- National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 569172State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China
| | - Ya Peng
- National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 569172State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China
| | - Xiaojin Gao
- National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 569172State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China
| | - Jingang Yang
- National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 569172State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China
| | - Haiyan Xu
- National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 569172State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China
| | - Yuan Wu
- National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 569172State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China
| | - Lei Song
- National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 569172State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China
| | - Shubin Qiao
- National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 569172State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China
| | - Fenghuan Hu
- National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 569172State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China
| | - Yang Wang
- National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 569172State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China
| | - Wei Li
- National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 569172State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China
| | - Chen Jin
- National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 569172State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China
| | - Yuejin Yang
- National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 569172State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China
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Lustosa RP, Fortuni F, van der Bijl P, Goedemans L, El Mahdiui M, Montero-Cabezas JM, Kostyukevich MV, Ajmone Marsan N, Bax JJ, Delgado V, Knuuti J. Left ventricular myocardial work in the culprit vessel territory and impact on left ventricular remodelling in patients with ST-segment elevation myocardial infarction after primary percutaneous coronary intervention. Eur Heart J Cardiovasc Imaging 2021; 22:339-347. [PMID: 32642755 DOI: 10.1093/ehjci/jeaa175] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/21/2020] [Accepted: 06/07/2020] [Indexed: 12/18/2022] Open
Abstract
AIMS Adverse left ventricular (LV) remodelling after ST-segment elevation myocardial infarction (STEMI) is associated with poor outcome. Global and regional LV myocardial work (LVMW) derived from speckle tracking echocardiographic strain data in combination with non-invasive blood pressure recordings could provide information for prediction of LV remodelling after STEMI. The aim of the study was to assess the predictive value of global and regional LVMW for LV remodelling before discharge in patients with STEMI. METHODS AND RESULTS Three-hundred and fifty STEMI patients treated with primary percutaneous coronary intervention (PCI) were included [265 men (76%), mean age: 61 ± 10 years]. Clinical variables, conventional echocardiographic parameters, global and regional measures of myocardial work index (MWI), and myocardial work efficiency were recorded before discharge. The primary endpoint was early LV remodelling defined as increase in LV end-diastolic volume (LVEDV) ≥20% at 3 months after STEMI. Eighty-seven patients (25%) showed early LV remodelling. The global and regional LVMW in the culprit territory were significantly lower in patients with early LV remodelling. Peak troponin I (OR 1.109, 95% CI 1.046-1.177; P = 0.001), LVEDV (OR 0.972, 95% CI 0.959-0.984; P < 0.001) and regional MWI in the culprit vessel territory (OR 0.602, 95% CI 0.383-0.945; P = 0.027) were independently associated with early LV remodelling. CONCLUSION In STEMI patients treated with primary PCI and optimal medical therapy, the regional cardiac work index in the culprit vessel territory before discharge is independently associated with early adverse LV remodelling.
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Affiliation(s)
- Rodolfo P Lustosa
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Federico Fortuni
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Pieter van der Bijl
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Laurien Goedemans
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Mohammed El Mahdiui
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Jose M Montero-Cabezas
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Marina V Kostyukevich
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Juhani Knuuti
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, 2300 RC Leiden, The Netherlands.,Turku PET Centre, Turku University Hospital and University of Turku, Kiinamllynkatu 4-8, 20520, Turku, Finland
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Suthahar N, Meijers WC, Silljé HHW, de Boer RA. From Inflammation to Fibrosis-Molecular and Cellular Mechanisms of Myocardial Tissue Remodelling and Perspectives on Differential Treatment Opportunities. Curr Heart Fail Rep 2017; 14:235-250. [PMID: 28707261 PMCID: PMC5527069 DOI: 10.1007/s11897-017-0343-y] [Citation(s) in RCA: 182] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW In this review, we highlight the most important cellular and molecular mechanisms that contribute to cardiac inflammation and fibrosis. We also discuss the interplay between inflammation and fibrosis in various precursors of heart failure (HF) and how such mechanisms can contribute to myocardial tissue remodelling and development of HF. RECENT FINDINGS Recently, many research articles attempt to elucidate different aspects of the interplay between inflammation and fibrosis. Cardiac inflammation and fibrosis are major pathophysiological mechanisms operating in the failing heart, regardless of HF aetiology. Currently, novel therapeutic options are available or are being developed to treat HF and these are discussed in this review. A progressive disease needs an aggressive management; however, existing therapies against HF are insufficient. There is a dynamic interplay between inflammation and fibrosis in various precursors of HF such as myocardial infarction (MI), myocarditis and hypertension, and also in HF itself. There is an urgent need to identify novel therapeutic targets and develop advanced therapeutic strategies to combat the syndrome of HF. Understanding and describing the elements of the inflammatory and fibrotic pathways are essential, and specific drugs that target these pathways need to be evaluated.
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Affiliation(s)
- Navin Suthahar
- Department of Cardiology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Wouter C Meijers
- Department of Cardiology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Herman H W Silljé
- Department of Cardiology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Rudolf A de Boer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands.
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van Loon RB, Veen G, Kamp O, Baur LHB, van Rossum AC. Left ventricular remodeling after acute myocardial infarction: the influence of viability and revascularization - an echocardiographic substudy of the VIAMI-trial. Trials 2014; 15:329. [PMID: 25135364 PMCID: PMC4141086 DOI: 10.1186/1745-6215-15-329] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 08/01/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Viability seems to be important in preventing ventricular remodeling after acute myocardial infarction (AMI). We investigated the influence of viability, as demonstrated with low-dose dobutamine echocardiography, and the role of early revascularization on the process of left ventricular (LV) remodeling after AMI. METHODS We retrospectively investigated 224 patients who were initially included in the viability-guided angioplasty after acute myocardial infarction-trial (VIAMI-trial). Patients in the VIAMI-trial did not undergo a primary or rescue percutaneous coronary intervention and were stable in the early in-hospital phase. Patients underwent viability testing within 72 hours after AMI. Patients with viability were randomized to an invasive strategy or an ischemia-guided strategy. Follow-up echocardiography was performed at a mean of 205 days. In this echocardiographic substudy, patients were divided into three new groups: group 1, viable and revascularized before follow-up echocardiogram; group 2, viable, but medically treated; and group 3, non-viable patients. RESULTS Group 1 showed preservation of LV volume indices. The ejection fraction (EF) increased significantly from 54.0% to 57.5% (P = 0.047). Group 2 showed a significant increase in LV volume indices with no improvement in EF (53.3% versus 53.0%, P = 0.86). Group 3 showed a significant increase in LV volume indices, with a decrease in EF from 53.5% to 49.1% (P = 0.043). Multivariate logistic regression analysis indicated the number of viable segments and revascularization during follow-up as independent predictors for EF improvement, especially in patients with lower EF at baseline. CONCLUSION Viability early after AMI is associated with improvement in LV function after revascularization. When viable myocardium is not revascularized, the LV tends to remodel with increased LV volumes, without improvement of EF. Absence of viability results in ventricular dilatation and deterioration of EF, irrespective of revascularization status. TRIAL REGISTRATION NCT00149591 (assigned: 6 September 2005).
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Affiliation(s)
- Ramon B van Loon
- Department of Cardiology, 5F003, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
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Goel PK, Bhatia T, Kapoor A, Gambhir S, Pradhan PK, Barai S, Tewari S, Garg N, Kumar S, Jain S, Madhusudan P, Murthy S. Left ventricular remodeling after late revascularization correlates with baseline viability. Tex Heart Inst J 2014; 41:381-8. [PMID: 25120390 DOI: 10.14503/thij-13-3585] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
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.
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Affiliation(s)
- Pravin K Goel
- Departments of Cardiology (Drs. Bhatia, Garg, Goel, Kapoor, Kumar, and Tewari) and Nuclear Medicine (Drs. Barai, Gambhir, Jain, Madhusudan, Murthy, and Pradhan), Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Tanuj Bhatia
- Departments of Cardiology (Drs. Bhatia, Garg, Goel, Kapoor, Kumar, and Tewari) and Nuclear Medicine (Drs. Barai, Gambhir, Jain, Madhusudan, Murthy, and Pradhan), Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Aditya Kapoor
- Departments of Cardiology (Drs. Bhatia, Garg, Goel, Kapoor, Kumar, and Tewari) and Nuclear Medicine (Drs. Barai, Gambhir, Jain, Madhusudan, Murthy, and Pradhan), Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Sanjay Gambhir
- Departments of Cardiology (Drs. Bhatia, Garg, Goel, Kapoor, Kumar, and Tewari) and Nuclear Medicine (Drs. Barai, Gambhir, Jain, Madhusudan, Murthy, and Pradhan), Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Prasanta K Pradhan
- Departments of Cardiology (Drs. Bhatia, Garg, Goel, Kapoor, Kumar, and Tewari) and Nuclear Medicine (Drs. Barai, Gambhir, Jain, Madhusudan, Murthy, and Pradhan), Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Sukanta Barai
- Departments of Cardiology (Drs. Bhatia, Garg, Goel, Kapoor, Kumar, and Tewari) and Nuclear Medicine (Drs. Barai, Gambhir, Jain, Madhusudan, Murthy, and Pradhan), Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Satyendra Tewari
- Departments of Cardiology (Drs. Bhatia, Garg, Goel, Kapoor, Kumar, and Tewari) and Nuclear Medicine (Drs. Barai, Gambhir, Jain, Madhusudan, Murthy, and Pradhan), Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Naveen Garg
- Departments of Cardiology (Drs. Bhatia, Garg, Goel, Kapoor, Kumar, and Tewari) and Nuclear Medicine (Drs. Barai, Gambhir, Jain, Madhusudan, Murthy, and Pradhan), Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Sudeep Kumar
- Departments of Cardiology (Drs. Bhatia, Garg, Goel, Kapoor, Kumar, and Tewari) and Nuclear Medicine (Drs. Barai, Gambhir, Jain, Madhusudan, Murthy, and Pradhan), Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Suruchi Jain
- Departments of Cardiology (Drs. Bhatia, Garg, Goel, Kapoor, Kumar, and Tewari) and Nuclear Medicine (Drs. Barai, Gambhir, Jain, Madhusudan, Murthy, and Pradhan), Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Ponnusamy Madhusudan
- Departments of Cardiology (Drs. Bhatia, Garg, Goel, Kapoor, Kumar, and Tewari) and Nuclear Medicine (Drs. Barai, Gambhir, Jain, Madhusudan, Murthy, and Pradhan), Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Siddegowda Murthy
- Departments of Cardiology (Drs. Bhatia, Garg, Goel, Kapoor, Kumar, and Tewari) and Nuclear Medicine (Drs. Barai, Gambhir, Jain, Madhusudan, Murthy, and Pradhan), Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
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Oraby MA, Ibrahim MF, Nasr GM, El Hawary AA. Relationship between restrictive Doppler mitral inflow pattern and myocardial viability after a first acute myocardial infarction. Egypt Heart J 2012. [DOI: 10.1016/j.ehj.2012.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Cortigiani L, Bigi R, Sicari R. Is viability still viable after the STICH trial? Eur Heart J Cardiovasc Imaging 2012; 13:219-226. [DOI: 10.1093/ejechocard/jer237] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Berstein LL, Grishkin YN, Novikov VI. Prediction of postinfarction remodeling of the left ventricle from parameters of tissue Doppler echocardiography. Bull Exp Biol Med 2008; 145:478-9. [PMID: 19110598 DOI: 10.1007/s10517-008-0122-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The possibility of predicting undesirable postinfarction remodeling of the left ventricle from parameters of tissue doppler echocardiography was evaluated in 55 patients with a history of acute myocardial infarction. Low diastolic rates of normal segments and the absence of the peak of isovolumetric contraction in the dysfunction zone were the most significant predictors of unfavorable remodeling.
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Affiliation(s)
- L L Berstein
- M. S. Kushakovskii Department of Cardiology, St. Petersburg Medical Upgrading Academy, Russian Ministry of Health, Russia.
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Peri-infarct pacing with CRT in the early postinfarct phase to attenuate long-term remodeling. J Cardiovasc Transl Res 2008; 2:126-9. [PMID: 20559976 DOI: 10.1007/s12265-008-9059-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Accepted: 09/08/2008] [Indexed: 10/21/2022]
Abstract
Deleterious left ventricular remodeling routinely occurs after myocardial infarction (MI) and novel strategies to attenuate this phenomenon may prove valuable. Here, we describe the potential role of left ventricular (LV) peri-infarct pacing (delivered via biventricular pacemakers) to reduce post-MI remodeling. Regional wall stress in the infarcted area is predictive of remodeling and therefore represents a potential therapeutic target. Using an intrinsic property of pacing to reduce stress and work at the pacing site, there are animal data to suggest that long-term peri-infarct pacing can have a salutary effect on cardiac structure after MI. This concept was tested in a pilot human study, suggesting attenuation of ventricular dilation in post-MI patients treated with LV pacing compared with control. To further characterize this concept, a 110-patient, multicenter, randomized Prevention of Myocardial Enlargement and Dilatation post-Myocardial Infarction Study (MENDMI) has completed enrollment. Inclusion criteria included anterior MI, QRS < 120 ms, ejection fraction <or= 35%, CPK > 2,000, and wall motion abnormalities in at least five of 16 segments. MENDMI will help to determine whether chronic application of peri-infarct pacing provides structural and clinical benefits and will help in the design of further investigations to modify postinfarction ventricular remodeling.
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Chan J, Khafagi F, Young AA, Cowan BR, Thompson C, Marwick TH. Impact of coronary revascularization and transmural extent of scar on regional left ventricular remodelling. Eur Heart J 2008; 29:1608-17. [PMID: 18556718 DOI: 10.1093/eurheartj/ehn247] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
AIMS Transmural extent (TME) of myocardial scar, contractile reserve, and perfusion all predict improvement in regional myocardial function after coronary revascularization. We sought their association with regional remodelling after infarction. METHODS AND RESULTS We studied 89 patients (age 62 +/- 10 years) with left ventricular (LV) dysfunction, at least 1 month post infarction. Viability was identified by TME < 75% on contrast-enhanced magnetic resonance imaging (ce-MRI), augmentation at low-dose dobutamine echocardiography (DbE), or >60% uptake on delayed redistribution on TI-201 SPECT (single photon emission computed tomography). Coronary revascularization was performed in 36 patients. Regional LV end-diastolic volume (EDV) and end-systolic volume, and ejection fraction were measured with MRI at baseline and after a median follow-up of 18 months. Of 357 segments identified with subendocardial infarction (TME 0-25%) on ce-MRI, 176 were revascularized. Subendocardial scar segments were associated with reverse regional remodeling during follow-up. Revascularization was an independent correlate of change in EDV, but TME and revascularization showed no interaction with respect to their influence on regional volumes. Contractile reserve was present on DbE in 228 segments, of which 129 were TME 0-25%; remodelling was associated with intervention in non-transmural infarcts showing viability by DbE. Viability was identified by TI-201 SPECT in 381 segments (233 with TME 0-25%), but viability by SPECT was not associated with reverse remodelling. No significant reverse remodelling occurred in segments with intermediate scar thickness (TME 26-75%) or transmural scar, independent of revascularization or viability by DbE or TI-SPECT. CONCLUSION Reverse regional remodelling is associated with subendocardial infarction, especially in the setting of contractile reserve and revascularization.
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Affiliation(s)
- Jonathan Chan
- Department of Medicine, University of Queensland, Princess Alexandra Hospital, Ipswich Road, Brisbane, Qld 4102, Australia
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11
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Early predictors of left ventricular function improvement late after myocardial infarction. VOJNOSANIT PREGL 2008; 65:9-14. [PMID: 18368932 DOI: 10.2298/vsp0801009m] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIM Prognosis after acute myocardial infarction (AIM) depends on the extent of irreversibly damaged myocardium and viable tissue due to stunning or hibernation. The aim of the study was to assess the prognostic significance of early echocardiographic parameters of myocardial viability in prediction of late recovery of regional and global ventricular function. METHODS The study prospectively included 40 patients after the first, uncomplicated univessel AIM treated with percutaneous coronary intervention (PCI). Low dose dobutamine echocardiography (LDDE) was preformed 7-10 days after AIM and follow-up resting echocardiography from 7 to 12 months later. RESULTS The sensitivity and specificity for the prediction of post revascularisation regional, dys synergy improvement were 61.29% and 94.59% respectively. The positive and negative predicative values were 90.48% and 74.47% re spectively. The number of viable segments (p = 0.01) and extent of contractile reserve (p = 0.01) were univariate, independent predictors of improvement in ejection fraction (EF). From the multivariate stepwise regression analysis contractile reserve was selected as most powerful predictor of late recovery of left ventricular contractile function (p = 0.007). Receiving-operator characteristic curve (ROC) analysis demonstrated that three or more recovered segments were necessary for an improvement of left ventricular ejection fraction (LVEF) > or = 5% after the revascularisation, with the highest sensitivity, 100% and specificity 56% (p = 0.01). CONCLUSION Low-dose dobutamine echocardiography is a powerful predictor of the regional dys synergy recovery late after AIM treated with PTCA with implantation stent. Late full functional improvement of the left ventricle is related to the extent of contractile reserve and amount of viable tissue. At least three recovered segments are necessary for a significant recovery of the global left ventricular contractility.
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Abbate A, Biondi-Zoccai GGL, Appleton DL, Erne P, Schoenenberger AW, Lipinski MJ, Agostoni P, Sheiban I, Vetrovec GW. Survival and cardiac remodeling benefits in patients undergoing late percutaneous coronary intervention of the infarct-related artery: evidence from a meta-analysis of randomized controlled trials. J Am Coll Cardiol 2008; 51:956-64. [PMID: 18308165 DOI: 10.1016/j.jacc.2007.11.062] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2007] [Revised: 11/21/2007] [Accepted: 11/26/2007] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Our purpose was to perform a systematic review and meta-analysis of randomized trials comparing percutaneous coronary intervention (PCI) of the infarct-related artery (IRA) with medical therapy in patients randomized >12 h after acute myocardial infarction (AMI). BACKGROUND There is ongoing uncertainty about the risk-benefit ratio of late PCI in stable patients with AMI. METHODS PubMed, CENTRAL, and other databases were searched (July 2007). Studies were included if they compared PCI with medical management and randomized patients >12 h and up to 60 days after AMI, and were excluded if patients were hemodynamically unstable. Odds ratios (ORs) were pooled for dichotomous outcomes, with all-cause mortality as the primary end point. Left cardiac remodeling parameters were also pooled with generic inverse-variance weighting. RESULTS We retrieved 10 studies that enrolled 3,560 patients, with median time from AMI to randomization of 12 days (range 1 to 26 days), and follow-up of 2.8 years (42 days to 10 years). Randomization allocated 1,779 subjects to PCI and 1,781 to medical treatment. There were 112 (6.3%) and 149 (8.4%) deaths in the 2 groups, respectively, yielding significantly improved survival in the PCI group (OR 0.49 [95% confidence interval (CI) 0.26 to 0.94], p = 0.030). These benefits were associated with similarly favorable effects on cardiac remodeling, such as improved left ventricular ejection fraction in the PCI group (+4.4% change [95% CI 1.1 to 7.6], p = 0.009). CONCLUSIONS Percutaneous coronary intervention of the IRA performed late (12 h to 60 days) after AMI is associated with significant improvements in cardiac function and survival.
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Affiliation(s)
- Antonio Abbate
- Virginia Commonwealth University-VCU Pauley Heart Center, Richmond, Virginia 23298, USA.
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Coser A, Franchi E, Marini M, Cemin R, Benini A, Beltrame F, Marini A, Pascotto M, Rognoni A, Ambrosio G, Marino PN. Intravenous contrast echocardiography after myocardial infarction: relationship among residual myocardial perfusion, contractile reserve and long-term remodelling. J Cardiovasc Med (Hagerstown) 2007; 8:1012-9. [DOI: 10.2459/jcm.0b013e32801da2bd] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Chung ES, Menon SG, Weiss R, Schloss EJ, Chow T, Kereiakes DJ, Mazur W, Salo RW, Galle E, Pastore JM. Feasibility of Biventricular Pacing in Patients With Recent Myocardial Infarction: Impact on Ventricular Remodeling. ACTA ACUST UNITED AC 2007; 13:9-15. [PMID: 17268205 DOI: 10.1111/j.1527-5299.2007.05868.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
To test the hypothesis that biventricular pacing after a myocardial infarction with reduced ejection fraction can attenuate left ventricular (LV) remodeling, the authors studied 18 patients (myocardial infarction within 30-45 days, ejection fraction <or=30%, narrow QRS) randomized to biventricular therapy (biventricular therapy + defibrillator) (biventricular group) or implantable cardioverter-defibrillator alone (control group). At 1, 6, and 12 months, there were no differences in functional or clinical parameters (New York Heart Association, quality of life, 6-minute walk). Twelve-month LV volume remained stable in the biventricular group, but increased in the control group (median LV end-diastolic volume increase, 6.5 mL in biventricular vs 35 mL in control; P=.03; median LV end-diastolic volume decrease, 5.5 mL in biventricular vs 30.5-mL increase in control; P=.11). Biventricular therapy also prevented an increase in sphericity index at 12 months (median, -2% in biventricular vs 37% in control; P=.06). Delivery of biventricular therapy early after myocardial infarction appears safe and feasible and may attenuate subsequent LV dilation.
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Affiliation(s)
- Eugene S Chung
- The Christ Hospital, Ohio Heart and Vascular Center, and the Lindner Clinical Trial Center, Cincinnati, OH 45219, USA.
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Abbate A, Bussani R, Biondi-Zoccai GGL, Santini D, Petrolini A, De Giorgio F, Vasaturo F, Scarpa S, Severino A, Liuzzo G, Leone AM, Baldi F, Sinagra G, Silvestri F, Vetrovec GW, Crea F, Biasucci LM, Baldi A. Infarct-related artery occlusion, tissue markers of ischaemia, and increased apoptosis in the peri-infarct viable myocardium. Eur Heart J 2005; 26:2039-45. [PMID: 16030061 DOI: 10.1093/eurheartj/ehi419] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
AIMS Unfavourable cardiac remodelling often complicates acute myocardial infarction (AMI) as a result of increased cardiomyocyte apoptosis. It is currently unclear whether ongoing or recurrent ischaemia is an independent determinant for increased apoptosis in peri-infarct viable myocardium. METHODS AND RESULTS In order to assess the link between infarct-related artery (IRA) occlusion, ischaemia, and apoptosis, 30 subjects dying 7-120 days after AMI (16 with IRA occlusion and 14 with patent IRA) and five control subjects were selected at autopsy. Cardiomyocytes were defined as apoptotic if co-expressing TUNEL and activated caspase-3. Expression of both hypoxia-inducible factor-1 and cyclo-oxygenase-2 was assessed in the peri-infarct myocardium and considered as tissue markers of ischaemia. Evidence of ischaemia was significantly more frequent in cases with IRA occlusion (53%) than in cases with patent IRA (15%) or control hearts (0%, P=0.026). The finding of IRA occlusion and markers of ischaemia identified cases with higher apoptotic rates (ARs) in the peri-infarct viable myocardium [12.2% (8.2-14.0), P<0.001 vs. others], whereas IRA occlusion without ischaemia was associated with lower AR, not significantly different from patent IRA [3.0% (1.0-7.9) vs. 2.2% (1.0-5.8), respectively, P=0.42] CONCLUSION Ischaemia in the peri-infarct viable myocardium is present in over 50% of subjects dying late after AMI with IRA occlusion, and it is associated with increased apoptosis. Relief of ischaemia after AMI may prove of benefit in preventing apoptosis and its consequences.
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Affiliation(s)
- Antonio Abbate
- Department of Medicine, Virginia Commonwealth University MCV Campus, Richmond, VA, USA.
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Bellenger NG, Yousef Z, Rajappan K, Marber MS, Pennell DJ. Infarct zone viability influences ventricular remodelling after late recanalisation of an occluded infarct related artery. Heart 2005; 91:478-83. [PMID: 15772205 PMCID: PMC1768832 DOI: 10.1136/hrt.2004.034918] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To investigate the influence of infarct zone viability on remodelling after late recanalisation of an occluded infarct related artery. METHODS A subgroup of 26 volunteers from TOAT (the open artery trial) underwent dobutamine stress cardiovascular magnetic resonance at baseline to assess the amount of viable myocardium present with follow up to assess remodelling at one year. TOAT studied patients with left ventricular dysfunction after anterior myocardial infarction (MI) associated with isolated proximal occlusion of the left anterior descending coronary artery with randomisation to percutaneous coronary intervention (PCI) with stent at 3.6 weeks after MI (PCI group) or to medical treatment alone (medical group). RESULTS In the PCI group there was a significant relation between the number of viable segments within the infarct zone and improvement in end systolic volume index (-7.7 ml/m2, p = 0.02) and increased ejection fraction (4.1%, p = 0.03). The relation between viability and improvements in end diastolic volume index (-8.8 ml/m2, p = 0.08) and mass index (-6.3 g/m2, p = 0.01) did not reach significance (p = 0.27 and p = 0.8, respectively). In the medical group, there was no significant relation between the number of viable segments in the infarct zone and the subsequent changes in end diastolic (p = 0.84) and end systolic volume indices (p = 0.34), ejection fraction (p = 0.1), and mass index (p = 0.24). CONCLUSION The extent of viable myocardium in the infarct zone is related to improvements in left ventricular remodelling in patients who undergo late recanalisation of an occluded infarct related artery.
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Affiliation(s)
- N G Bellenger
- Cardiovascular MR Unit, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, London, UK.
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Abe Y, Muro T, Sakanoue Y, Komatsu R, Otsuka M, Naruko T, Itoh A, Yoshiyama M, Haze K, Yoshikawa J. Intravenous myocardial contrast echocardiography predicts regional and global left ventricular remodelling after acute myocardial infarction: comparison with low dose dobutamine stress echocardiography. Heart 2005; 91:1578-83. [PMID: 15797931 PMCID: PMC1769245 DOI: 10.1136/hrt.2004.057521] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To assess the role of intravenous myocardial contrast echocardiography (MCE) in predicting functional recovery and regional or global left ventricular (LV) remodelling after acute myocardial infarction (AMI) compared with low dose dobutamine stress echocardiography (LDSE). METHODS 21 patients with anterior AMI and successful primary angioplasty underwent MCE and LDSE during the subacute stage (2-4 weeks after AMI). Myocardial perfusion and contractile reserve were assessed in each segment (12 segment model) with MCE and LDSE. The 118 dyssynergic segments in the subacute stage were classified as recovered, unchanged, or remodelled according to wall motion at six months' follow up. Percentage increase in LV end diastolic volume (%DeltaEDV) was also calculated. RESULTS The presence of perfusion was less accurate than the presence of contractile reserve in predicting regional recovery (55% v 81%, p < 0.0001). However, the absence of perfusion was more accurate than the absence of contractile reserve in predicting regional remodelling (83% v 48%, p < 0.0001). The number of segments without perfusion was an independent predictor of %DeltaEDV, whereas the number of segments without contractile reserve was not. The area under the receiver operating characteristic curve showed that the number of segments without perfusion predicted substantial LV dilatation (%DeltaEDV > 20%) more accurately than did the number of segments without contractile reserve (0.88 v 0.72). CONCLUSION In successfully revascularised patients with AMI, myocardial perfusion assessed by MCE is predictive of regional and global LV remodelling rather than of functional recovery, whereas contractile reserve assessed by LDSE is predictive of functional recovery rather than of LV remodelling.
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Affiliation(s)
- Y Abe
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
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Visser CA. Left ventricular remodelling after myocardial infarction: importance of residual myocardial viability and ischaemia. Heart 2003; 89:1121-2. [PMID: 12975390 PMCID: PMC1767895 DOI: 10.1136/heart.89.10.1121] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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