TY - JOUR
T1 - Relation of initial infarct size to extent of left ventricular remodeling in the year after acute myocardial infarction
AU - Chareonthaitawee, Panithaya
AU - Christian, Timothy F.
AU - Hirose, Ken
AU - Gibbons, Raymond J.
AU - Rumberger, John A.
N1 - Funding Information:
From the Division of Cardiovascular Disease and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota. Dr. Rumberger is a recipient of the American Heart Association Established Investigator Award, American Heart Association, Dallas, Texas. This study was supported in part by EI duPont deNemours and Company, North Billerica, Massachusetts and the Mayo Clinic and Foundation, Rochester, Minnesota. Manuscript received July 4, 1994; revised manuscript received October 4, 1994, accepted October 6, 1994. Address for correspondence: Dr. Timothy F. Christian, Mayo Clinic, 200 First Street, SW, Rochester, Minnesota 55905.
PY - 1995/3/1
Y1 - 1995/3/1
N2 - Objectives.: This study attempted to determine the relation between infarct size after acute myocardial infarction and subsequent left ventricular remodeling using precise clinical measurements. Background.: Animal studies have demonstrated that the degree of left ventricular remodeling after myocardial infarction is linearly related to infarct size. Clinical studies have not clearly replicated these results because of imprecise measurements and failure to adjust for patency of the infarct-related artery. Methods.: Infarct size was measured from technetium-99m (Tc-99m) sestamibi perfusion images in 14 patients (12 with an anterior, 2 with an inferior infarction) by a threshold method previously described and expressed as percent of the left ventricle (32 ± 17% left ventricle [mean ±SD], range 6% to 58%). Absolute end-systolic volume, end-diastolic volume and ejection fraction were determined by electron beam computed tomographic images performed at discharge and at 6 weeks, 6 months and 1 year after myocardial infarction. All patients had documented infarct related artery patency after reperfusion therapy. Results.: At hospital discharge, there was no correlation between infarct size and end-systolic and end-diastolic volumes or ejection fraction. There was significant left ventricular dilation in the study group over the next year. As remodeling progressed, there was closer correlation between infarct size and ejection fraction and end-systolic volume measures (infarct size vs. end-systolic volume, from r = 0.43 at discharge to r = 0.80 at 1 year; infarct size vs. ejection fraction, from r = -0.39 at discharge to r = -0.84 at 1 year). There was a strong inverse correlation between infarct size at discharge and subsequent changes over the next year in end-systolic volume (r = 0.63, p = 0.02) and ejection fraction (r = -0.66, p = 0.01). Conclusions.: Infarct size as measured by Tc-99m sestamibi at hospital discharge after an index infarction is predictive of subsequent change in left ventricular volume and function in the year after myocardial infarction. Patients with a large infarct demonstrated the greatest degree of dilation in the setting of patency of the infarct-related artery.
AB - Objectives.: This study attempted to determine the relation between infarct size after acute myocardial infarction and subsequent left ventricular remodeling using precise clinical measurements. Background.: Animal studies have demonstrated that the degree of left ventricular remodeling after myocardial infarction is linearly related to infarct size. Clinical studies have not clearly replicated these results because of imprecise measurements and failure to adjust for patency of the infarct-related artery. Methods.: Infarct size was measured from technetium-99m (Tc-99m) sestamibi perfusion images in 14 patients (12 with an anterior, 2 with an inferior infarction) by a threshold method previously described and expressed as percent of the left ventricle (32 ± 17% left ventricle [mean ±SD], range 6% to 58%). Absolute end-systolic volume, end-diastolic volume and ejection fraction were determined by electron beam computed tomographic images performed at discharge and at 6 weeks, 6 months and 1 year after myocardial infarction. All patients had documented infarct related artery patency after reperfusion therapy. Results.: At hospital discharge, there was no correlation between infarct size and end-systolic and end-diastolic volumes or ejection fraction. There was significant left ventricular dilation in the study group over the next year. As remodeling progressed, there was closer correlation between infarct size and ejection fraction and end-systolic volume measures (infarct size vs. end-systolic volume, from r = 0.43 at discharge to r = 0.80 at 1 year; infarct size vs. ejection fraction, from r = -0.39 at discharge to r = -0.84 at 1 year). There was a strong inverse correlation between infarct size at discharge and subsequent changes over the next year in end-systolic volume (r = 0.63, p = 0.02) and ejection fraction (r = -0.66, p = 0.01). Conclusions.: Infarct size as measured by Tc-99m sestamibi at hospital discharge after an index infarction is predictive of subsequent change in left ventricular volume and function in the year after myocardial infarction. Patients with a large infarct demonstrated the greatest degree of dilation in the setting of patency of the infarct-related artery.
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U2 - 10.1016/0735-1097(94)00431-O
DO - 10.1016/0735-1097(94)00431-O
M3 - Article
C2 - 7860898
AN - SCOPUS:0028929031
SN - 0735-1097
VL - 25
SP - 567
EP - 573
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 3
ER -