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Influence of Infarct-Zone Viability on Left Ventricular Remodeling After Acute Myocardial Infarction

医学 心脏病学 心肌梗塞 内科学 心室重构 血管成形术 多巴酚丁胺 血流动力学
作者
Leonardo Bolognese,Giampaolo Cerisano,Piergiovanni Buonamici,Alberto Santini,Giovanni Maria Santoro,David Antoniucci,Pier Filippo Fazzini
出处
期刊:Circulation [Ovid Technologies (Wolters Kluwer)]
卷期号:96 (10): 3353-3359 被引量:125
标识
DOI:10.1161/01.cir.96.10.3353
摘要

Background The relation between residual myocardial viability after acute myocardial infarction (AMI) and ventricular remodeling has yet to be fully elucidated. We hypothesized that the presence of residual viability would favorably influence left ventricular remodeling after AMI and that serial changes in left ventricular dimensions might be related to the extent of myocardial viability in the infarct zone. Methods and Results Ninety-three patients with a first AMI successfully treated with primary coronary angioplasty underwent two-dimensional echocardiography within 24 hours of admission and low-dose dobutamine echocardiography at a mean of 3 days after AMI. Two-dimensional echocardiography and coronary angiography were obtained in all patients 1 and 6 months after coronary angioplasty. On the basis of dobutamine echocardiography responses, patients were divided in two subsets: those with (n=48; group I) and those without (n=45; group II) infarct-zone viability. There was no difference in minimal lesion diameter and infarct-related artery patency at 1 and 6 months between the two groups. Group II patients had significantly greater end-diastolic (76±18 versus 53±14 mL/m 2 ; P <.0003) and end-systolic (42±17 versus 22±11 mL/m 2 ; P <.0003) volumes at 6 months than did patients in group I. The extent of infarct-zone viability was significantly inversely correlated with percent changes in end-diastolic volumes at 6 months ( r =−.66; P <.000001) and was the most powerful independent predictor of late left ventricular dilation. Conclusions After reperfused AMI, the degree of left ventricular dilation, when it occurs, is inversely related to the extent of residual myocardial viability in the infarct zone. Thus, the absence of residual infarct-zone viability discriminates patients who develop progressive left ventricular dilation after reperfused AMI from those who maintain normal left ventricular geometry.

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