Cardiac remodelling in the era of aggressive medical therapy: does it still exist?

• Published in: International journal of cardiology Vol. 83; no. 3; pp. 217 - 225
• Main Authors: Bellenger, Nicholas G, Swinburn, Jonathan M.A, Rajappan, Kim, Lahiri, Avijit, Senior, Roxy, Pennell, Dudley J
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 01.06.2002; Elsevier Science
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Cardiovascular magnetic resonance; Cardiovascular system; Female; Follow-Up Studies; Humans; Male; Medical sciences; Middle Aged; Miscellaneous; Myocardial infarction; Myocardial Infarction - drug therapy; Myocardial Infarction - physiopathology; Pharmacology. Drug treatments; Remodelling; Stroke Volume - drug effects; Stroke Volume - physiology; Ventricular Remodeling - drug effects; Myocardial infarction; Cardiovascular magnetic resonance; Remodelling; Human; Drug; Prognosis; Infarct; Pathophysiology; Treatment efficiency; Cardiovascular disease; Exploration; Remodeling; Coronary heart disease; Myocardial disease; Nuclear magnetic resonance imaging; Left ventricle; Chemotherapy; Treatment; Myocardium; Medical imagery; Hemodynamics; Predictive factor; Left ventricle performance
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/S0167-5273(02)00034-7

Aim: To delineate the natural history of left ventricular remodelling following large anterior myocardial infarction (MI), in the era of aggressive medical therapy. Methods: Seventeen selected patients underwent cardiovascular magnetic resonance (CMR) at 2 weeks and 1, 3, 6 and 12 months post infarction. Results: There was a significant increase in left ventricular (LV) end-diastolic volume index (EDVI) and LV ESVI from 2 weeks to 1 month ( P<0.05) but no significant change thereafter. The LV ejection fraction (EF) decreased from 2 weeks to 1 month ( P<0.05) and then increased over the year ( P=0.02). Throughout the study period the sphericity index increased. There was a significant and progressive decrease in LV mass index over the year, which was associated with a decrease in wall thickness at both the infarct and non-infarct sites. Independent predictors of an early increase in LVESVI were increasing age, increasing CK-MB and not receiving treatment with a statin. Conclusion: This study delineates the natural history of left ventricular remodelling in the modern medical era in those patients who have suffered a large anterior MI. Classical remodelling occurred up to 1 month, but thereafter was attenuated. These findings would suggest that remodelling is not as prevalent in the modern era, and that combined medical management with thrombolysis, ACEi, beta-blockers and statins may strongly influence the development of this remodelling.