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Left ventricular remodeling after primary coronary angioplasty: patterns of left ventricular dilation and long-term

Leonardo Bolognese1, Aleksandar N Neskovic, Guido Parodi

  • 1Division of Cardiology, S. Donato Hospital, Arezzo, Italy. leonardobolognese@hotmail.com

Circulation
|October 31, 2002
PubMed

Insights

Left ventricular remodeling after acute myocardial infarction (AMI) treated with primary percutaneous transluminal coronary angioplasty (PTCA) is common. Six-month left ventricular dilation predicts worse outcomes, not the dilation pattern.

Area of Science:

  • Cardiology
  • Cardiovascular Research
  • Interventional Cardiology

Background:

  • Left ventricular (LV) remodeling after acute myocardial infarction (AMI) impacts patient prognosis.
  • The prevalence, patterns, and prognostic significance of LV remodeling post-primary percutaneous transluminal coronary angioplasty (PTCA) require further clarification.

Purpose of the Study:

  • To prospectively evaluate the prevalence, patterns, and prognostic impact of LV remodeling after successful primary PTCA in patients with AMI.
  • To determine the association between LV remodeling patterns and long-term clinical outcomes.

Main Methods:

  • Prospective study of 284 patients with AMI treated with primary PTCA.
  • Serial echocardiographic and angiographic assessments at 24 hours, 1 month, and 6 months post-AMI.
  • Long-term clinical follow-up (mean 61 months) for survival and adverse events.

Main Results:

  • 30% of patients exhibited LV dilation at 6 months post-AMI compared to baseline.
  • Early, late, and progressive dilation patterns were observed in 15%, 14%, and 13% of patients, respectively.
  • LV dilation at 6 months was associated with significantly higher rates of cardiac death and combined events (P=0.005 and P=0.025).

Conclusions:

  • Left ventricular remodeling, characterized by dilation, occurs even after successful primary PTCA.
  • LV dilation at 6 months post-AMI is a significant predictor of worse long-term clinical outcomes.
  • The specific pattern of LV dilation did not significantly influence long-term survival.
Abstract

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