Infarct zone viability influences ventricular remodelling after late recanalisation of an occluded infarct related artery

• Published in: Heart (British Cardiac Society) Vol. 91; no. 4; pp. 478 - 483
• Main Authors: Bellenger, N G, Yousef, Z, Rajappan, K, Marber, M S, Pennell, D J
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Cardiovascular Society 01.04.2005; BMJ; BMJ Publishing Group LTD; Copyright 2005 by Heart
• Subjects: Adult; Aged; Angioplasty, Balloon, Coronary; Biological and medical sciences; Cardiology. Vascular system; Cardiotonic Agents; cardiovascular magnetic resonance; Cardiovascular Medicine; CMR; Dobutamine; EDV; EDVI; ejection fraction; Electrocardiography; end diastolic volume; end diastolic volume index; end systolic volume; end systolic volume index; Enzymes; ESV; ESVI; Follow-Up Studies; Heart attacks; Humans; Hypertension; LAD; left anterior descending coronary artery; left ventricular; magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; mass index; Medical imaging; Medical sciences; Medical treatment; Middle Aged; myocardial infarction; Myocardial Infarction - pathology; Myocardial Infarction - physiopathology; Myocardial Infarction - therapy; Patients; PCI; percutaneous coronary intervention; percutaneous transluminal coronary angioplasty; Pilot Projects; PTCA; remodelling; should we intervene following thrombolysis?; SWIFT; TAMI-6; the open artery trial; thrombolysis and angioplasty in myocardial infarction-6; thrombolysis in myocardial infarction; Time Factors; TIMI; TOAT; Veins & arteries; Ventricular Dysfunction, Left - pathology; Ventricular Dysfunction, Left - physiopathology; Ventricular Remodeling; viability; Volunteers; Late; Infarct; Viability; Zone; Artery
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/hrt.2004.034918

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.