Correlation Between Acute Impairment of Regional Contractility and Left Ventricular Remodeling after Revascularized Acute Myocardial Infarction

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Introduction: The present study aims to demonstrate the role of acute impairment of regional contractility, as assessed by 3D echocardiography, in predicting LV remodeling in post acute myocardial infarction (AMI) patients.

Methods: We enrolled in the study a number of 48 subjects with AMI who underwent primary PCI followed by optimum medical therapy. In all these cases we followed the correlation between the amplitude of ventricular remodeling at 6 months postinfarction and regional contractility in the immediate postinfarction period, as assessed by 3D echo parameters at baseline: regional index of contraction amplitude (RICA) and the index of contraction amplitude (ICA). Positive remodeling (PR) was defined as an increase in LV end-diastolic global volume with >15% compared with baseline.

Results: Patients with positive remodeling (PR) presented at baseline a significantly lower ejection fraction (44.75% versus 49.95%, p = 0.009), associated with a higher end-systolic volume (80.34 ml vs. 70.63 ml, p = 0.02) and lower values for index of contraction amplitude — ICA (3.05 vs. 3.53, p = 0.01) and for regional index of contraction amplitude — RICA (1.38 vs. 2.78, p <0.0001), in comparison with the patients who did not experience ventricular remodeling. RICA achieved the best statistical significance for predicting the development of LV remodeling during the evolution of the disease. For RICA, the ROC curve using logistic analysis showed an area under the curve (AUC) of 0.88, highly significant (p = 0.0001).

Conclusions: Impairment of regional contractility is associated with development of LV remodeling to a more significant extent than the global impairment of ventricular contractility.

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  • 1. Wenk JF Klepach D Lee LC et al. First evidence of depressed contractility in the border zone of a human myocardial infarction. Ann Thorac Surg. 2012;93:1188-1193.

  • 2. Lipiecki J Durel N Ernande L Monzy S Muliez A Ponsonnaille J. Different patterns of left ventricular enlargement and long-term prognosis after reperfused acute myocardial infarction. Arch Cardiovasc Dis. 2009;102:599-605.

  • 3. Ghanem A Troatz C Elhafi N et al. Quantitation of myocardial borderzone using reconstructive 3-D echocardiography after chronic infarction in rats: incremental value of low-dose dobutamine. Ultrasound Med Biol. 2008;34:559-566.

  • 4. Barletta G Antoniucci D Buonamici P Toso A Del Bene R Fantini F. Left ventricular shape and function in primary coronary angioplasty. Int J Cardiol. 2008;125:364-375.

  • 5. Carluccio E Biagioli P Alunni G et al. Patients with hibernating myocardium show altered left ventricular volumes and shape which revert after revascularization: evidence that dyssynergy might directly induce cardiac remodeling. J Am Coll Cardiol. 2006;47:969-977.

  • 6. Silva JC Rochitte CE Júnior JS et al. Late coronary artery recanalization effects on left ventricular remodelling and contractility by magnetic resonance imaging. Eur Heart J. 2005;26:36-43.

  • 7. Danchin N Angioi M Marie PY et al. Effect of late revascularization of the responsible artery after infarction on left ventricular function and remodeling. Arch Mal Coeur Vaiss. 1997;90:47-51.

  • 8. Sutton MJ Sharpe N. Left Ventricular Remodeling After Myocardial Infarction: Pathophysiology and Therapy. Circulation. 2000;101:2981-2988.

  • 9. Bolognese L Neskovic AN Parodi G et al. Left ventricular remodeling after primary coronary angioplasty: patterns of left ventricular dilation and long-term prognostic implications. Circulation. 2002;106:2351-2357.

  • 10. Nijland F Kamp O Verhorst PM de Voogt WG Bosch HG VIsser CA. Myocardial viability: impact on left ventricular dilatation after acute myocardial infarction. Heart. 2002; 87:17-22.

  • 11. Jenkins C Bricknell K Hanekom L Marwick TH. Reproducibility and accuracy of echocardiographic measurements of left ventricular parameters using real-time threedimensional echocardiography. J Am Coll Cardiol. 2004;44:878-886.

  • 12. Mannaerts H van der Heide JA Kamp O Stoel MG Twisk J Visser CA. Early identification of left ventricular remodelling after myocardial infarction assessed by transthoracic 3D echocardiography. European Heart Journal. 2004;25:680-687.

  • 13. Udelson JE. The Occluded Artery Trial (OAT) Viability Ancillary Study (OATNUC): Influence of Infarct Zone Viability on Left Ventricular Remodeling After Percutaneous Coronary Intervention vs. Optimal Medical Therapy Alone. Am Heart J. 2011;161:611-621.

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