Abstract and Introduction
Abstract
Aims: Few data are available on the extent and prognostic value of reverse left ventricular remodelling (r-LVR) after ST-elevation acute myocardial infarction (STEMI). We sought to evaluate incidence, major determinants, and long-term clinical significance of r-LVR in a group of STEMI patients treated with primary percutaneous coronary intervention (PPCI). In particular, the role of preserved microvascular flow within the infarct zone in inducing r-LVR has been investigated.
Methods and Results: Serial echocardiograms (2DE) and myocardial contrast study were obtained within 24 h of coronary recanalization (T1) and at pre-discharge (T2) in 110 reperfused STEMI patients. Follow-up 2DE was scheduled after 6 months (T3). Two-year clinical follow-up was obtained. Reverse remodelling was defined as a reduction > 10% in LV end-systolic volume (LVESV) at 6 months follow-up. r-LVR occurred in 39% of study population. At multivariable analysis, independent predictors of r-LVR were an effective microvascular reflow within the infarct zone, the in-hospital improvement of myocardial perfusion, an initial large LVESV, and a short time to reperfusion. Cox analysis identified r-LVR as the only independent predictor of 2-year event-free survival. Combined events rate was significantly higher among patients without compared to those with r-LVR (log-rank test P < 0.05).
Conclusion: r-LVR frequently occurs in STEMI patients treated with PPCI and it is an important predictor of favourable long-term outcome. A preserved microvascular perfusion within the infarct zone is the major determinant of r-LVR.
Introduction
Left ventricle remodelling (LVR) is a relatively common and unfavourable event occurring after acute myocardial infarction (AMI). The extent of microvascular damage after reperfusion has been identified as one of the main determinant of this process.
On the other hand, the opposite phenomenon, LV volume reduction after coronary reperfusion, known as reverse LVR (r-LVR), has been poorly investigated. A significant r-LVR has been recently described after cardiac resynchronization therapy (CRT) in patients with chronic heart failure and it is a strong predictor of longer long-term survival and less adverse cardiac events. r-LVR was also observed after ST-elevation acute myocardial infarction (STEMI). However, few data are available on the extent, determinants, and clinical significance of r-LVR after STEMI in modern clinical practice with a systematic use of primary percutaneous coronary intervention (PPCI) and 'antiremodelling' medications. This information might have important clinical implications for the design and interpretation of trials aimed at evaluating the efficacy of new therapeutic options in patients with STEMI.
Thus, we analysed the Acute Myocardial Infarction Contrast Imaging (AMICI) multicenter study database to investigate incidence, major determinants, and long-term prognostic impact of r-LVR in a group of STEMI patients treated with PPCI. Furthermore, as the extent of microvascular damage is one of the key determinants of LVR we assessed the role of microvascular flow changes after reperfusion in inducing r-LVR.